Hazmat Shipping Request FormShipper's Information Requestor's Name * Shipper's Name Department Name Building Address City, State, Zip Code Telephone Number E-mail Address Recipient's Information Recipient's Name Company Name Shipping Address City, State, Zip Code Telephone Number E-mail Address Is this an international shipment? Yes No Has the shipment been approved by the Export Control Office? Yes No FedEx Account Information Sender's 9-digit FedEx Account Number Recipient's 9-digit FedEx Account Number Description of the Material Being Sent If the material is from a human or animal source, reference any technical names, strains, etc. If the material is a chemical, reference any chemical names and percent of solution. Do the contents contain any pathogens, viruses, or anything harmful to humans or animals? Yes No If yes, specify: Are the samples preserved? Yes No If yes, in what? At what % solution? Is dry ice being used? Yes No You must provide your own. If yes, how many pounds? Contents of Package Number of Primary Containers in Package Volume Per Primary Container Units - None -mLuLLiterugmggramsKglbOther Container Material - None -GlassMetalPlastic Container Type - None -CylinderTubeBottleBoxDrum Additional Notes The samples and dry ice should be in the box, but do not seal the box. Remove any old labels that are not associated with this shipment. Please give 24hr advance notice to allow for scheduling. We will make every effort to accommodate same-day requests, but you must understand there may be prior requests being processed and there will be no guarantee your shipment can go out on short notice. EHS will complete the shipping papers, provide proper labels, and arrange for pickup of the package. EHS can provide UN-approved packaging, when required. Leave this field blank
