Download Hazardous Material Information Sheet

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