Chemical Inventory Building _______________ Room # _____
COMMON NAME OF SUBSTANCE (Not Formula) FORM OF MATERIAL TYPE OF CONTAINER CONDITION OF CONTAINER D.O.T. CLASS LEGEND
FORM OF MATERIAL





TYPE OF CONTAINER




D.O.T. CLASS
SIZE OF
CONTAINER
SIGNATURE OF PERSON DROPPING OFF
CONTAINER
1
2
3
 
!

 "#
$$
5 %#&

'(&)*& 
&
7 +& 
8
9&,#