Troxler 4640-B - D-2 Sample Common Carrier Bill of Lading

Appendix D–8
SB Freightways
BILL OF LADING
DATE
SHIP DATE
P.O. NO. SHIPPER NO.
CONSIGNEE (TO)
RED E. WAITING
SHIPPER/CONSIGNOR (FROM)
ABC PAVING COMPANY
DEF PAVING INTERNATIONAL 456 MAIN STREET
123 DIRT ROAD ANY OTHER TOWN, U.S.A. 67890
ANYTOWN, U.S.A. 12345
PHONE NO. EMERGENCY RESPONSE NUMBER* (REQUIRED IF HM COLUMN MARKED)
919-549-9539
ROUTE
(SUBJECT TO CORRECTION)
Number of
Packages
HM
*
Kind of Packaging, Description of Articles,
Special Marks and Exceptions
Weight
(lb)
Class or
Rate Ref.
Cube
(Optional)
1 x Radioactive Material, Type A package,
Special Form, 7, UN3332
Cs-137 0.30 GBq (8.0 mCi)
Radioactive Yellow II label, TI = 0.2
Dim 42 x 40 x 62 cm
Emergency Contact: (919) 549-9539
THIS IS TO CERTIFY THAT THE ABOVE-NAMED MATERIALS ARE PROPERLY CLASSIFIED, DESCRIBED, PACKAGED,
MARKED, AND LABELED AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO THE APPLICABLE
REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION.
SHIPPER/CONSIGNOR
WANDA SHIPPITT
CARRIER
SB FREIGHTWAYS
AUTHORIZED SIGNATURE DATE AUTHORIZED SIGNATURE
Figure D–2. Sample Common Carrier Bill of Lading