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NSSI
Lab Pack Drum Inventory Form

Generator Name:

DOT Shipping Name:

Hazard Class:

UN/NA ID No.:

NSSI Profile No. :

Generator Drum No. : sheet of per durm

Outer Container Type/Size:

UN/NA ID No. :

NOTE: Line item numbers on this sheetmust be entered on labels affixed to inner containers holding materials/chemicals identified on the corresponding line. Materials/Chemicals that appear in the "U" or "P" hazardous waste list must have the EPA hazardous waste code; otherwise, enter "used", "spent" or "more than one active ingredient", if it applies, to explain why the code is not assigned.

Line Item No. Quantity and Unit (5 x 10 ml) Materials/Chemical Name or Description EPA Haz. Waste Codes Physical State Container Type Container Type Comments

CERTIFICATION: The listing above is an accurate and complete description of the contents of this drum, and they are packed in accordance to 49 CFR'173.12.

Generator Name
Packed By
Signature