Document zzx3eyVzk9aGwBXNXw62Q1gXa

BEQUEST FOR SHIPPING TO: Plant or Company L-Jr o. Attention , / -.rL n C_\-4-.bw< -/ U.-vrji-K' / iC.,Cv,,M NotcC > Address a 2-Q SklLf; .") CityCwcC} Description of Shipment ______ . . . .......................... ...................... State A1 X" .Zip -Xy 1 S' Date. V' Za - ci 3 Phone (.?') Vc Chemical Name- ^ d IX..... - r (ifapplicable) Haskell#_____________________ MR# -Tit C-- O___________ _______________ , ------------------------ --- ------------------- -----:------------- Type of inner pkg l? t ____Sample VoDwt. ._LT No. of inner pkgs. Total No. of containers --------------------- ------ ----- ^ HAZARDOUS MATERIAL it'd [NO YES, ((F YES, COMPLETE CLASSIFICATION BELOW) CHECK HAZARD CLASSIFICATION, ASTERISK SECONDARY CLASSIFICATION (SEE REVERSE SIDE FOR DEFINITIONS) EXPLOSIVES CLASS AD ETIOLOGIC AGENT ORGANIC PEROXIDE RADIOACTIVE MATERIALS (**) POISONOUS GAS. CLASS A POISONOUS LIQUID, CLASS A BD - CD OXIDIZER FLAMMABLE SOLID CORROSIVE MATERIAL (LIQUID) POISONOUS LIQUID, CLASS B ., POISONOUS SOLID, CLASS B, ' v" CORROSIVE MATERIAL (SOLID): .- ....- . ......-...... .....:......... ..... ......... . : ' ' .............. '........ ..... _D,,= ....... ., P'P; FLAMMABLE GAS NONFLAMMABLE GAS FLAMMABLE.UQU1D (') (BELOW 100F) IRRITATING MATERIAL COMBUSTIBLE LIQUID (*) (BETWEEN 100F & 200) OTHER REGULATED MATERIAL A BD CD DO ED CARCINOGEN OSHAO STRONG (*) FLASH POINT--TAG. C.C. F. .. .v.:: -:.V . . . : v--r (**) SHIPMENT MUST BE APPROVED BYTHE RADIOLOGICAL SAFETY OFFICER MATERIALS WHICH COULD POLYMERIZE OR DECOMPOSE IN TRANSIT ARE PROHIBITED Basis for Hazard Classification (References etc.) _ SPECIAL: INSTRUCTIONS. Tt^ Kvv'/<- ia . c : (if none indicate) RIGNFO..... ' CHEMiST/SUPERVISOR *' ` -V tj [ Rl ill DING T v* - REVIEWED & APPROVED ;; :!' - " TO b e :c o mp l e t e d b y c o mmit t e e '' SHIPPING NAME -_____ LIMITED QUANTITY YES Q NO D DOT COORDINATOR OR DESIGNATE ( DUP040002189,