Design by:
TEST REQUEST FOR HAZMAT PACKAGES
1A. Your Company Name: 1B. Purchase Order # for this test: 1C. Name and phone number of Hazmat Specialist:
1A. Your Company Name:
1B. Purchase Order # for this test:
1C. Name and phone number of Hazmat Specialist:
2. PRODUCT INFORMATION (found in MSDS):
2A. TRADE NAME (Brand Name): 2B. PROPER SHIPPING NAME*: 2C. UN NUMBER: (NUMBER BOX): 2D. HAZARDOUS CLASS: 2E. PACKING GROUP*: 2F. SPECIFIC GRAVITY*: 2G. FOR SOLIDS, PARTICLE SIZE IS: Powder Salt Sand Birdseed Corn Peanuts Pecan size Other
2A. TRADE NAME (Brand Name):
2B. PROPER SHIPPING NAME*:
2C. UN NUMBER: (NUMBER BOX):
2D. HAZARDOUS CLASS:
2E. PACKING GROUP*:
2F. SPECIFIC GRAVITY*:
2G. FOR SOLIDS, PARTICLE SIZE IS:
3. SHIPPING INFO
3A. MODE OF TRANSPORTATION OF PACKAGE IS*: GROUND AIR OCEAN 3B. MAXIMUM PACKAGE SHIPPING WEIGHT*: lbs 3C. IF LIQUID, VOLUME OF LIQUID SHIPPED IN ONE CARTON: gallons 4A. OUTER PACKAGE IS*: CORRUGATED CARTON DRUM WOVEN BAG WOODEN CRATE 4B. IF 4G PACKAGE, OUTER CARTON STYLE IS: 4E. MANUFACTURER OF OUTER*: 5A. OTHER STRUCTURAL COMPONENTS OF PACKAGE: PE FOAM POLYURETHANE FOAM PARTITIONS CORRUGATED DIVIDERS CORRUGATED PADS CORRUGATED INSERTS 5B. PLEASE DESCRIBE STRUCTURAL COMPONENT DETAILS:
3A. MODE OF TRANSPORTATION OF PACKAGE IS*:
3B. MAXIMUM PACKAGE SHIPPING WEIGHT*: lbs
3C. IF LIQUID, VOLUME OF LIQUID SHIPPED IN ONE CARTON: gallons
4A. OUTER PACKAGE IS*:
4B. IF 4G PACKAGE, OUTER CARTON STYLE IS:
4E. MANUFACTURER OF OUTER*:
5A. OTHER STRUCTURAL COMPONENTS OF PACKAGE:
5B. PLEASE DESCRIBE STRUCTURAL COMPONENT DETAILS:
6. OUTER (CARTON) CLOSURE OR SEALING METHOD:
6A. TAPED TAPE THICKNESS: mils TAPE WIDTH: inches TAPE BRAND 6B. GLUED IF GLUED, ADHESIVE TYPE IS: COLD HOTMELT BRAND OR SPEC OF ADHESIVE PLACEMENT OF BEADS: 6C. STITCHED NUMBER AND PLACEMENT OF STITCHES: 6D. OTHER CLOSURE DETAIL: 6E. IF NOT A 4G PACKAGE PLEASE DESCRIBE CLOSURE:
6B. GLUED
IF GLUED, ADHESIVE TYPE IS:
COLD HOTMELT
BRAND OR SPEC OF ADHESIVE
PLACEMENT OF BEADS:
6C. STITCHED
NUMBER AND PLACEMENT OF STITCHES:
6D. OTHER CLOSURE DETAIL:
6E. IF NOT A 4G PACKAGE PLEASE DESCRIBE CLOSURE:
7A. INNER PACKAGE IS:
HDPE BOTTLE GLASS BOTTLE INNER CARTON METAL DRUM OTHER 7B. NOMINAL CAPACITY OF ONE INNER PACKAGE IS*: 7C. WEIGHT IN GRAMS OF INNER PACKAGE IS: 7D. MANUFACTURER OF INNER PACKAGE IS*: 7E. MANUFACTURING PROCESS IS:
7B. NOMINAL CAPACITY OF ONE INNER PACKAGE IS*:
7C. WEIGHT IN GRAMS OF INNER PACKAGE IS:
7D. MANUFACTURER OF INNER PACKAGE IS*:
7E. MANUFACTURING PROCESS IS:
8A. BOTTLE/INNER CLOSURE IS (e.g. cap, plug, lid)
8B. CLOSURE DIAMETER IS 8C. CLOSURE TORQUE IS inchpounds 8D. CLOSURE HAS INNER LINER: YES NO 8E. CLOSURE IS INDUCTION SEALED: YES NO 8F. MANUFACTURER OF CLOSURE IS*:
8B. CLOSURE DIAMETER IS
8C. CLOSURE TORQUE IS inchpounds
8D. CLOSURE HAS INNER LINER: YES NO
8E. CLOSURE IS INDUCTION SEALED: YES NO
8F. MANUFACTURER OF CLOSURE IS*:
1) This form with all applicable fields completed 2) At least six undamaged (unused) boxes with their inner components Materials must represent the EXACT materials to be used in production 3) Drawings of Outer and Inner Packages and their Test Certificates where applicable 4) Purchase order or other payment (if PO #, fill out on first page item 1B)
