Model 4640-B Appendix D–9
D. TRANSPORTATION
NOTE
The Shipper’s Declaration of Dangerous Goods must be
completed for all shipments transported by air.
Figure D–3. Sample Shippers Declaration for Dangerous Goods
Radioactive Material, 7 UN3332
Type A package, Special Form
Cesium-137, 0.30 GBq (8 mCi) Yellow SPECIAL
II FORM CERT.
Dim 42 x 40 x 62 cm GB/353/S85
TI=0.2
DIM
42x40x
62 cm
This shipment may be carried on passenger aircraft outside U.S. jurisdiction.
Special Form Approval certification is attached to dangerous goods declaration.
EMERGENCY CONTACT: (01) 1-919-549-9539
ABC PAVING COMPANY
123 DIRT ROAD
ANYTOWN, U.S.A. 12345
XXXXXXXXX
XXXXXXXXX
XXXXXXXXX
XXXXXXXXXXXXXXX
DEF PAVING INTERNATIONAL
456 MAIN STREET
ANY OTHER TOWN, U.S.A. 67890
Wanda Shippitt, Shipping Coordinator
ANYTOWN, U.S.A. Ship Date
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