Note:
The name and address is not required when the package is:
(1) Transported by highway only and will not be transferred from one motor carrier to another; or
(2) Part of a carload lot, truckload lot or freight container load, and the entire contents of the rail car,
truck, or freight container are shipped from one consignor to one consignee.
ATURE AND QUANTITY OF DANGEROUS GOODS
Dangerous Goods Identification
Proper Shipping Name
Class
Un
Pack-
Subsi
Quantity and
Packing
Authoriz
or
or
ing
diary
Type of
Inst
ation
Divis
ID
Group
Risk
Packing
ion
No.
LITHIUM HYDRIDE
FUSED, SOLID
Lithium Hydride, Fused Solid
4.3
UN2805
II
Fibreboard
416
ONE BOX
Box X 15 KG
UN2805
FLAMMABLE
METAL
Additional Handling Information
Incorrect
Correct
Emergency Contact No. 1-800-851-8061
I hearby declare that thecontents of this consignmentare truly and
Name and Title fo Signatory
accurately described above by the proper shipping name, and are
classified,packaged, marked and labelled/placarded, and are in all
Place and Date
respects in proper condition for transport according to applicable
international and national governmental regulations.
Signature
(see warning above)
* Compare PSN and identification number on the shipping paper to markings on the package.
SPECIFIC REQUIREMENTS
* Liquid hazardous material (section 172.312) requires that each non-bulk combination packaging
having inner packagings containing liquid hazardous materials be legibly marked with orientation
arrows on at least two opposite verticle sides.
* Hazardous substances (section 172.324) shall have the name of the hazardous substance as part of the
PSN if it is not included in the PSN. If shipping a reportable quantity, the letters "RQ" shall be marked
on the package in association with the PSN.
* ORM D (section 172.316) must be marked with the ORM-D designation within a rectangle on at least
one side or end immediately following or below the PSN of the material.
* DOT exemptions (section 172.301) shall be marked with "DOT-E" followed by the assigned exemption
number.
* Poisonous hazardous materials (section 172.313) that are poisonous by inhalation will be marked
"Inhalation Hazard" in association with the required labels or placards.
E-4
