TM 10-6640-238-13
HAZARDOUS MATERIAL SHIPPING PAPER
page 5 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
1
500
grams
Sodium Chloride
500 grams
2
500
grams
X
Sodium Hydroxide, solid, 8, UN1823, II
1000 grams
Corrosive
1
500
grams
Sodium Thiosulfate, pentahydrate
500 grams
2
500
grams
Starch, Soluble
1000 grams
5
2.5 L
X
Sulphuric acid, 8, UN1830, II
12.5 L
Corrosive
2
4 L
X
Toluene, 3, UN1294, II
8 liters
Flammable
Liquid
2
500 ml
X
Xylenes, 3, UN1307, III
1000 mls
Flammable
Liquid
1
500
grams
Zinc Oxide
500 grams
1
500
grams
Sodium Carbonate, anhydrous
500 grams
10
500
grams
Sodium Bicarbonate, ACS
5000 grams
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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