Toxic Gas Rail Transport Declaration
1. Shipper Information
Company / Shipper Name
Address
Contact Person
Contact Number
2. Consignee Information
Consignee Name
Address
Contact Number
3. Transport Details
Date of Shipment
Railcar Number(s)
Departure Station
Arrival Station
4. Description of Goods
UN Number
Proper Shipping Name
Hazard Class
Quantity
Container Type
Special Handling Instructions
5. Declaration
Declaration Statement
Authorized Signature
Date