HAZARDOUS MATERIAL SHIPPING PAPER

 

EMERGENCY RESPONSE TELEPHONE #:__________________
Date:___________

                       

Consignee:

______________________________

______________________________

______________________________ 

Shipper:

_____________________________

_____________________________

_____________________________

    

Number and Type of Pieces HM

Description: (MUST APPEAR IN SPECIFIED ORDER)

Proper Shipping Name / Hazard Class / UN/NA / Packing Group

 Total Weight(lbs)
 

 

 

      
 

 

 

      
 

 

 

      
 

 

 

      
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.

                       PER: ________________

IMPORTANT:
  1. PLEASE TYPE OR PRINT CLEARLY
  2. INCLUDE THE NUMBER OF AND THE TYPE OF CONTAINER
  3. MAKE SURE THAT THE DESCRIPTION IS COMPLETE AND IN THE PROPER ORDER
  4. THE TOTAL WEIGHT MUST BE FOLLOWED BY THE UNIT OF MEASURE (LBS, GAL, ETC)
  5. MORE THAN ONE HAZARDOUS MATERIAL MAY BE PUT ON ONE FORM PROVIDED ALL ARE GOING TO THE SAME CONSIGNEE
  6. SIGN THE FORM - AN UNSIGNED FORM IN NOT COMPLETE !
FORMS: MUST BE FILLED OUT COMPLETELY OR THE DRIVER MAY REFUSE TO PICK UP THE PACKAGES.