Document KR34gJ8xZ5L1a2v9kwvGVn700

Chemical Name L*? V'~v> (if applicable) Haskell # Type of inner pkg Total No. of containers MR# *\UGO -- _ Sample VoUwt. _ No. of inner pkgs....... HAZARDOUS MATERIAL .TO.NO - QYES .......(IFYES, COMPLETE CLASSIFICATION BELOW)~ - '( ; ~~ 7 ! ^ ~I?!*""rT.H" CHECK HAZARD CLASSIFICATION, ASTERISK SECONDARY CLASSIFICATION (SEE REVERSE SIDE FOR DEFINITIONS) .. , EXPLOSIVES . CLASS A p ETIOLOGIC AGENT ORGANIC PEROXIDE RADIOACTIVE MATERIALS (**) POISONOUS GAS. CUSS A POISONOUS LIQUID, CLASS A,. BQ . CD .. > OXIDIZER ` -- -- FUMMABLE SOLID ------ CORROSIVE MATERIAL (LIQUID) POISONOUS LIQUID, CUSS B . POISONOUS SOLID, CUSS B CORROSIVE MATERIAL (SOLID) ~ * FUMMABLEGAS NONFLAMMABLE GAS FLAMMABLE LIQUID (*) (BELOW 100F) ........ IRRITATING MATERIAL COMBUSTIBLE LIQUID ( ) o (BETWEEN 100 F& 200) OTHER REGULATED MATERIAL AQ BQ CQ DQ EQ ............ CARCINOGEN........OSHA _ST;RONG,,D.................. ................................ O FLASH POINT--TAG. C.C. _ ,, __F. ..... (") SHIPMENT MUST BE APPROVED BY THE RADIOLOGICAL SAFETY OFFICER MATERIALS WHICH COULD POLYMERIZE OR DECOMPOSE IN TRANSIT ARE PROHIBITED Basis for Hazard Classification (References etc.) ___ ___ ___ ______________ -- SPECIAL INSTRUCTIONS . Kv.S.f' \jiyf ia j m , '~TM (if none indicate) -J * f o~*~~ SIGNED IST/SUPERVISOR BUILDING. /W .RM. // JEXT. REVIEWED & APPROVED TO BE COMPLETED BY COMMITTEE SHIPPING NAME LIMITED QUANTITY YESQ NOQ ......... ......________ ____ ___r . ----------....______ ______ ________ ; v,_.......... DOT COORDINATOR OR DESIGNATE - ---------------------------- ------------------------------------------------------DUP040002172