TM 10-6640-238-13
HAZARDOUS MATERIAL SHIPPING PAPER
page 1 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
3
500 ml
X
Acetic Acid, glacial, 8, UN2789, II
1500 ml
Corrosive
Flammable Liq.
10
4L
X
Acetone, 3, UN1090, II
40 liters
Flammable Liq.
3
4L
X
Alcohols, flammable, toxic, n.o.s. (Ethanol, Methanol), 3, UN1986, II
{Denatured Alcohol}
12 liters
Flammable Liq.,
Toxic
3
500 ml
X
Ammonia Solution, 8, UN6272, III
1500 ml
Corrosive
10
500
grams
Calcium Chloride
5000 gms
1
500
grams
Calcium Sulfate
500 gm
2
50 lb.
cyl.
X
Carbon Dioxide, 2.2, UN1013
100 lbs
Non-flammable
gas
4
1 lb.
Charcoal, activated
4 lbs
1
500
grams
X
Corrosive solid, toxic, n.o.s. (Barium Hydroxide), 8, UN2923, II
500 gm
Corrosive
Toxic
2
2 kg
Desiccant
4 kg
1
100
grams
X
Dye, solid, toxic, n.o.s . (Methyl Orange), 6.1, UN3143, III
100 grams
Toxic
2
500 ml
X
Ethylene Glycol Monomethyl Ether, 3, UN1188, III
1000 ml
Flammable
Liquid
1
16 oz.
X
Flammable Liquid, nos (Stoddard Solvent), 3, UN1993, III
{Brasso}
16 oz.
Flammable
Liquid
2
500
grams
X
Flammable Liquid, toxic, n.o.s., (Diethylene Monomethyl Ether), 3,
UN1992, III
1000 grams
Flammable Liq.
Toxic
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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