Highly Reactive Substances Shipping Manifest
Shipment Information
Manifest Number
Date
Origin
Destination
Shipper Name
Shipper Contact
Receiver Name
Receiver Contact
Highly Reactive Substances List
#
Substance Name
Chemical Formula
Quantity
Packaging Type
Hazard Class
UN Number
Additional Notes
Special Handling Instructions
Emergency Contact
Name
Phone
Agency
Email
Shipper Signature
Date:
Receiver Signature
Date: