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NUN -NEGOTIABLE BILL - BILL Na. <br />AND TRANSPORTATION AGREL <br />PRINCIPAL � -� E� rp:4 13-0512602 <br />CARRIER •fir-..: - -- - �"'�- <br />= JO8 4 <br />ADDRESS 3 <br />BROILER # <br />C IT$ISTATEIZI P PH. TRUCK # <br />UNDERLYING CARRIER <br />CIF <br />ANY) = � _: I TRAILER # <br />ADDRESS - PH. CA# <br />SHIPPER.- i <br />i.� <br />RECEIVER• <br />ADDRESS <br />ADDRESS <br />€ <br />CITYISTATEIZIP�-',1L _ ;: - { <br />CITYISTATEIZIP <br />POINT OF ORIGIN <br />POINT OF DESTINATION <br />❑ HOURLY Q TONNAGE Q PER LOAD <br />* ❑SUPER TAG <br />❑ END DUMP <br />❑ FLAT BED <br />❑ IQ -WHEELER ❑ TRANSFER <br />❑ SIDE DUMP <br />❑ MIXER <br />0`SUPER-14 ❑ DBL BOTTOMS <br />Cl TRUCK & PUP <br />❑ SWEEPER <br />RATE @ $ <br />0 STRONG ARM ❑ SEMI -BOTTOM <br />❑ WATER TRUCK <br />❑ OTHER <br />0 <br />TAG -NO. <br />WEIGHT <br />CaiVIfNf7DRY <br />LOADING <br />ARRIVE DEPART <br />UNLOADING <br />ARRIVE <br />DEPART <br />STANDBY <br />TIME <br />BREAKDOWNOR <br />I REASON FOR DELAY <br />_ <br />ACCESSORIAL OTHER <br />TIME ' <br />RUNNINGTIME <br />SUBJECT TO TERMS AND TOTAL CHARGES <br />CONDITIONS ON REVERSE SIDE <br />�`���• 1 fs rr3� `' % JOB <br />DRIVER SIGNAT-URE f;� SHIPPERIRECEIVER (AGENT OR DE$ITpI2) SIGNATURE <br />W <br />� 2� <br />