HAZMAT MANIFEST

(Compressed Gas Cylinders)

This is a generic form and may not meet your state's requirements. Check with your state DOT!

DATE*

______/________/_________

Shipper

 

Name*:

 

 

Address:

 

 

City, State, Zip Code:

 

 

Emergency Number**:

 

 

QUANTITY*

DESCRIPTION OF CONTENTS*

 

_____ Cylinders

Air, Compressed, 2.2, UN1002 (less than 23.5% O2)

 

_____ Cylinders

Oxygen, Compressed, 2.2 / 5.1, UN1072

 

_____ Cylinders

Compressed Gas, OXIDIZING, 2.2, UN 3156, NOS

_____% Oxygen,  _____% Nitrogen,  _______% Helium

 

_____% Argon,  ______% Other (_________________________)

 

_____ Cylinders

Compressed Gas, NOS, 2.2, UN1956 (less than 23.5% O2)

_____% Oxygen,  _____% Nitrogen,  _______% Helium

 

_____% Argon,  ______% Other (_________________________)

 

Commercial carriers are limited to 1000 pounds (cylinders & contents) unless registered HAZMAT carriers!

Government HAZMAT Information Sources:

For more information on visual cylinder inspection contact:

DOT HAZMAT Help Line:

800-467-4922

DOT Motor Carrier Help Line:

800-832-5660

Professional Cylinder Inspectors, Inc.

www.psicylinders.com

425-398-4300

*Entry required by DOT

**Emergency number provided must be answered at all times load is in transit

Manifest must be kept for one year

 
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