HAZMAT MANIFEST
(Compressed Gas Cylinders)
This is a generic form and may not meet your state's requirements. Check with your state DOT!
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DATE* ______/________/_________ |
Shipper |
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Name*: |
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Address: |
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City, State, Zip Code: |
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Emergency Number**: |
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QUANTITY* |
DESCRIPTION OF CONTENTS* |
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_____ Cylinders |
Air, Compressed, 2.2, UN1002 (less than 23.5% O2) |
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_____ Cylinders |
Oxygen, Compressed, 2.2 / 5.1, UN1072 |
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_____ Cylinders |
Compressed Gas, OXIDIZING, 2.2, UN 3156, NOS _____% Oxygen, _____% Nitrogen, _______% Helium
_____% Argon, ______% Other (_________________________) |
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_____ 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!
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Government HAZMAT Information Sources: |
For more information on visual cylinder inspection contact: |
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DOT HAZMAT Help Line: 800-467-4922 DOT Motor Carrier Help Line: 800-832-5660 |
Professional Cylinder Inspectors, Inc. 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
