Environmental Health & Safety Office

Dangerous Goods Shipping Procedure:

This form will enable you to provide ChemTel with the required information for them to act as your 24-hour emergency contact. The number on the DG declaration for ChemTel will connect with a person who will be able to reference the information you have

provided. A copy of the Material Safety Data Sheet or safety fact sheet should be on file with EHSO prior to shipment. Fax to Attn: Hazardous Materials Shipment, Fax No: 312-413-3703.

For shipping hazardous materials, please fill out the form below:

Please use the TAB key to move between the fields.

Shipper Name: (person responsible for shipping materials)
Shipper Phone No.: (immediate contact number)
Shipper Email address: Courier: (name of transporting company
Shipment Date: (when shipment went out) Airbill Number: (tracking Number)
Total Volume on DGF: (amount shipped) Sample ID Range*:
Recipient: (where material is being shipped) Recipient Phone No.: (receiver's immediate contact number)
Dangerous Material Information: (proper shipping name)** Material or Product Name: (what is commonly known as other than the proper shipping name)

* OPTIONAL: If Hazmat shipment contains several different containers and these containers each hold a different type of material, then each container should have a unique identification number on it. This number is to be created by sender. This number can be any series of numbers or letter.
However, if the containers are all the same then they do not necessarily have to be individually identified.

** Proper shipping name required by the DOT (ID number, Class, Packing Group, Correct Shipping Name, Etc.)

Additional Information or Comments:
(User must press Return to move the insertion point to the next line in the text area)

If you have any questions about shipping Hazardous Materials at the University of Illinois at Chicago, please call EHSO at (312) 413-2436 or call Chem-Tel 24 hour Emergency Call Center at (800) 255-3924