TM 10-6640-238-13
HAZARDOUS MATERIAL SHIPPING PAPER
page 3 of 5
To:
consignee
From:
shipper
Street:
Street:
City:
Zip:
City:
Zip:
Phone #:
Phone #:
Delivering Carrier:
Vehicle#:
U.S. DOT HazMat Reg. #:
Qty
UNIT
SIZE
HM
Shipping Description (Shipping name, Hazard Class, ID #,
Packing Group)
Total
Amount
Labels
2
5 lbs
RQ
Mercury, 8, UN2809, II, Marine Pollutant
10 lbs
Corrosive
Marine Pollutant
2
4 L
X
Methyl Ethyl Ketone, 3, UN1193, II
8 liters
Flammable
Liquid
3
2.5 L
X
Nitric Acid, 8, UN2031, I
7.5 liters
Corrosive
Oxidizer
1
231 cu.
ft.
X
Nitrogen, compressed, 2.2, UN1066
231 cu ft
Cyl.
Non-flammable
gas
1
100
grams
X
Nitrophenols, 6.1, UN1663, III
100 grams
Keep away from
food stuff
1
5 gals
X
Octanes, 3, UN1262, II
5 gallon
Flammable
Liquid
10
1 gal.
Oil, Bath, Viscosimeter
10 gallons
1
3 kg.
Ottawa Sand
3 kg.
2
500 mg
X
Oxidizing Solid, n.o.s. (Sodium Dichromate), 5.1, UN1479, II
1000 mg
Oxidizer
6
100
grams
X
Oxidizing Solid, Toxic, n.o.s. (Potassium Dichromate), 5.1, UN3087, III
600 grams
Oxidizer, Toxic
1
230 cu.
ft.
X
Oxygen, compressed, 2.2, UN1072
230 cu ft.
cyl.
Non-flammable
gas, Oxidizer
3
1 gal.
X
Paint Related Materials, 3, UN1263, II
{Naphtha}
3 gallons
Flammable
Liquid
4
2.25 oz.
Paste, Gasoline Finding
9 oz.
4
3 oz.
Paste, Water Finding
12 oz.
3
1 gal.
X
Petroleum Distillates n.o.s., 3, UN1268, III
{Dry Cleaning Solvent}
3 gallons
Flammable
Liquid
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.
Signed:______________________________________________
Date: _________
EMERGENCY CONTACT: _________________________________________________
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