TM 10-6640-239-13
HAZARDOUS MATERIAL SHIPPING PAPER
page 1 of 3
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
10
4 L
X
Acetone, 3, UN1090, II
40 liters
Flammable
Liquid
1
500
grams
X
Barium compound, n.o.s., 6.1, UN1564, III, Poison
500 grams
Toxic
5
500 ml
Buffer Solution pH 10
2500 mls
5
500 ml
Buffer Solution pH 4
2500 mls
4
5 pints
X
Chloroform, 6.1, UN1888, III, Poison
2.5 gals.
Toxic
8
500 ml
X
Corrosive liquid, acidic, inorganic, n.o.s. (sulfuric acid, chromic
trioxide), 8, UN3264, II {Chromic-Sulfuric Cleaning Sol’n}
4000 ml
Corrosive
4
1 pint
X
Corrosive Liquid, acidic, inorganic, nos (Bromine), 8, UN3264, II
2 quarts
Corrosive
2
2 kg
Desiccant
4 kg
1
500 ml
X
Ethanol Solution, 3, UN1170, II
500 ml
Flammable
Liquid
3
1 L
X
Flammable liquid n.o.s. (Ethylene Glycol Monomethyl Ether), 3,
UN1993, III
3 liters
Flammable
Liquid
1
16 oz
X
Flammable Liquid nos (Stoddard Solvent), 3, UN1993, III {Brasso}
16 oz
Flammable
Liquid
6
500 ml
X
Flammable liquid, corrosive, n.o.s. (Isopropanol, Hydrochloric acid), 3,
UN2924, II {hydrochloric acid standard}
3 liters
Flammable Liq.
Corrosive
6
500 ml
X
Flammable Liquid, corrosive, n.o.s. (Isopropanol, Potassium
Hydroxide), 3, UN2924, II {potassium hydroxide standard}
3 liters
Flammable Liq.
Corrosive
1
1 L
X
Flammable Liquid, n.o.s. (Isopropanol) 3, UN1993, III
{methyl purple indicator}
1 liter
Flammable
Liquid
1
1.8 kg
General Purpose Detergent
1.8 kg
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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