TM 10-6640-239-13
HAZARDOUS MATERIAL SHIPPING PAPER
page 2 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
4
150
grams
Grease, Ground Glass Joint
600 grams
2
500 ml
X
Hydrochloric Acid, 8, UN1789, III
1000 ml
Corrosive
12
500 ml
X
Hydrogen Peroxide, aqueous solution, 5.1, UN2014, II
6 liters
Oxidizer
Corrosive
1
4 L
X
Isopropanol, 3, UN1219, II
4 liters
Flammable
liquid
1
5 gals.
X
Isopropanol, 3, UN1219, II
5 gallons
Flammable
Liquid
4
1 liter
Lubricating Oil, Vacuum Pump
4 liters
25
X
Mercury Contained in Manufactured Articles, 8, UN2809, III
25 Thermo-
meters
Corrosive
2
500
grams
X
Methanol, 3, UN1230, II, Poison
1000 grams
Flammable liq.
Toxic
1
5 gal.
X
Octanes, 3, UN1262, II
5 gallon
Flammable
Liquid
13
1 gal.
Oil, Bath
13 gallons
2
500 mg
X
Oxidizing solid, n.o.s. (Sodium Dichromate), 5.1, UN1479, I
1000 mg
Oxidizer
2
230 cu.
ft. cyl.
X
Oxygen, compressed, 2.2, UN1072
460 cu. ft.
Non-Flammable
gas, Oxidizer
2
1 gal
X
Paint related material, 3, UN1263, II {Naphtha}
2 gallons
Flammable
Liquid
1
1 liter
Paraffin
1 Liter
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: ____________________________________
|
|
