Dangerous Goods Shipping Request – Environmental Health and Safety

Name: *

Email Address: *

Phone Number: *

Principal Investigator: *

Department *

Building *

Room

Ship To

Name: *

Name of Institution or Company(If Applicable)

Address: *

Address:

City

State/Province

Zip/Postal

Country

Phone Number: *

Desired Arrival Date: *

Dangerous Goods Information

Location of dangerous goods:

Special instructions:

Chemical name: *

Amount: *

Container (current type and size): *

Chemical contents (if different from name): *

Is the chemical in the original outer packaging? *

Yes

No

Do you have the original shipping documentation? *

Yes

No

Original shipping document:

Maximum file size: 5MB

If you have the original shipping documentation, please scan and attach to this page (PDF preferred, DOC acceptable), or fax it to 801-585-7240 with the reference number you will receive once you submit this profile.

MSDS is available? *

Yes

No

Original MSDS:

Maximum file size: 5MB

DO NOT UPLOAD FILES WITH AMPERSANDS OR PERCENT SIGNS IN THE FILENAME If you have the original MSDS, please scan and attach to this page (PDF preferred, DOC acceptable), or fax it to 801-585-7240 with the reference number you will receive once you submit this profile.

Chartfield

BU: *

ORG: *

Fund: *

Activity or project: *

Account *

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