Troxler 4640-B - D-4 Sample Federal Express Form

Appendix D–10
NOTE
The Federal Express form is equivalent to the Shipper’s
Declaration for Dangerous Goods shown in Figure D-3.
Figure D–4. Sample Federal Express Form
Radioactive Material, 7 UN3332
Type A package, Special Form
Cesium-137 Yellow SPECIAL
0.30 GBq (8.0 mCi) II FORM CERT.
GB/353/S85
Dim 42 x 40 x 62 cm TI=0.2
DIM
42x40x
62 cm
919-549-9539
WANDA SHIPPITT 444 444-4444
ABC PAVING COMPANY
123 DIRT ROAD
ANYTOWN U.S.A. 12345
X
XXXXXXXXXXXXX
RED E. WAITING 555 555-5555
DEF PAVING INTERNATIONAL
456 MAIN STREET
ANY OTHER TOWN U.S.A. 67890
Wanda Shippitt, Shipping Coordinator
ANYTOWN, U.S.A. Ship Date
XXXXXXXXX
XXXXXXXXX
NOTE