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Hazardous Material Information Sheet Contact Information Name: Department: Phone: Fax: E-mail Address: Chemical Information Chemical Percentages (%) Note: You must provide a Material Safety Data Sheet (MSDS) for each chemical. Most MSDS's can be obtained by accessing Environmental Health and Safety's website: http://ehs.ucdavis.edu/ Toxic Organic Flammable Inorganic Infectious Substance to: Poison Liquid Humans Corrosive Solid Animals Bio-Hazard Dry Ice kg. Container Information Type of Container: Glass Over Pack (i.e. vial) Metal Plastic Volume per container: Total volume amount per package: UN Specified Package Number Ground Air Method of Transportation Domestic City: State: International City: Country: Postal Code: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked, and labeled/placarded, are in all respects in proper condition for transport according to applicable international and national governmental regulations. Signature Date For Office Use Only Hazard Class: Proper Shipping Name: Mail Services Ship-out Program, Materiel Management Division UN ID number: Packing Group: http://materiel.ucdavis.edu/storehouse/shipout.cfm