SampleIMDGShippingformportabletank.doc - OOCL



[pic]

-----------------------

MULTIMODAL DANGEROUS GOODS FORM

This form maybe used as a dangerous good declaration as it meets the requirements of SOLAS 74, chapter regulation 4; MAROL 73/78, Annex III, regulation 4.

1. Shipper/ Consignor/ Sender

2. Transport document number: 99852

Combustible Research Co.

220 Capitol Expressway

San Jose, CA 95119

6. Consignee

Renewable Waste LLC

1776 Collins st.

Manchester England (UK)

3. Page 1 of 1 pages

Shipper’s Reference no.: 2520592685

5. Freight Forwarder’s Reference:

7. Carrier (to be completed by carrier):

SHIPPERS DECLARATION

I hereby declare that the contents of this consignment are fully and accurately described below by the Proper Shipping Name, and are classified, packaged, marked and labeled/ placecard and are in all respects in proper condition for transport according to the applicable international and national governments.

9. Additional Handling Information

8. This shipment is within limitations prescribed for

(Delete non-applicable)

CARGO AIRCRAFT

ONLY

PASSGENGER & CARGO

AIRCRAFT

Emergency Contact 1-888-621-1234

10. Vessel/flight no and date

OOCL California

11. Port/ Place of Loading

Flexistow, England

11. Port/ Place of Loading

Long Beach, CA

12. Destination

Manchester, England

DANGEROUS GOODS

• You must specify: Proper Shipping Name, hazard class, UN No. packing group, (where assigned) marine pollutant and observe the mandatory requirements under applicable national and international governmental regulations. For the purpose of the IMDG Code, see 5.4.1.4

• For the purpose of the IMDG see 5.4.2

Signature of Declarant

Signature of Driver

Signature of Declarant Ivy Rivera

Place and date: San Jose, CA (USA) 29/06/03

Name/Status of Delcarant:

Ivy Rivera/ Transport Supervisor

22. Name of company (shipper preparing this note)

Combustible Research Co.

Place and date:

Name/Status of Delclarant:

20. Name of company

CONTAINER VEHICLE PACKING CERTIFICATE

I hereby declare that the goods described above have been packaged/ loaded into the container/ vehicle identified above in accordance with the applicable provisions

MUST BE COMPLETED AND SIGNED FOR ALL CONTAINER/VEHICLE LOADS BY PERSON RESPONSIBLE FOR PACKING/ LOADING

Container identification No. /

Vehicle registration No.

: TKNU668451

16. Seal Number (s)

: N/A

17. Container vehicle size and type

: N/A

18. Tare mass (kg)

: 9600 kg

19. Total gross including tare (kg)

: 32500 kg

Hauler’s Name: Horace Hauling Ltd.

Vehicle registration No.:

Signature and date

21. RECEIIVING ORGANIZATION RECEIPT

Received the above number of packages/ container/ trailers in apparent good order and

Condition, unless state hereon: RECEIVING ORGANIZATION REMARKS

14. Shipping marks *Number and kind of packages, description of goods Gross mass (kg) Net mass (kg) Cube (m²)

1 type 2 tank UN1112, AMYL NITRATES, CLASS 3, flashpoint 48.0C, III, EMS No. F-E S-D 24000

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download