Appendix D–12
Date:
Ship Date
Initial Carrier:
Canadian Freight Company
Document ID Number:
#####
Consignor:
ABC Paving International
123 Dirt Road
Anytown, Province L9T9S9
Consignee:
Wanda Shippitt
456 Main Street
Other Town, Province L3T3S3
UNITS TYPE DG Shipping Name
1
pkg
X
Radioactive Material, Type A Package,
Special Form, Class 7, UN3332,
Cs-137 0.30 GBq (8 mCi),
Radioactive Yellow II label, TI=0.2, Four Class 7
placards required
EMERGENCY CONTACT: 1-919-549-9539, Troxler Electronic
Laboratories, Inc.
This shipping document is issued under the authority of the consignor per
______________________________________ Date _________
Required items include:
Date
Initial Carrier
Document ID Number
Consignor Name & Address
Consignee Name & Address
Radionuclides
Label Category
Emergency Telephone Number
Statement of Authority
X in the Dangerous Goods (DG) Column
Shipping Name
Class
UN Number
Package Authorization
Activity in Units of Becquerel
Transportation Index (for other than White I)
Number and Type of Placards (unless the
licensee has an Equivalent Level of Safety
Permit issued by Transport Canada)
Figure D–5. Sample Canadian Bill of Lading
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