SHIPPER'S DECLARATION FOR DANGEROUS GOODS

1 SHIPPER'S DECLARATION FOR DANGEROUS GOODS shipper PHONE NUMBER: DSN: AIR WAYBILL NO SHIPPER'S REFERENCE NUMBER TCN: PAGE PAGES OF CONSIGNEE COMPLETED AND SIGNED COPIES OF THIS DECLARATION MUST BE HANDED TO THE OPERATOR WARNING Failure to comply in all respects with applicable Hazardous Materials/ DANGEROUS GOODS Regulations may be in breach of the applicable law, subject to legal penalties TRANSPORTATION DETAILS THIS SHIPMENT IS WITHIN THE LIMITATIONS PRESCRIBED FOR: (DELETE NON-APPLICABLE) CARGO AIRCRAFT ONLY PASSENGER AND CARGO AIRCRAFT AIRPORT OF DEPARTURE: NON-RADIOACTIV RADIOACTIV SHIPMENT TYPE: (DELETE NON-APPLICABLE) AIRPORT OF DESTINATION: NATURE AND QUALITY OF DANGEROUS GOODS DANGEROUS GOODS QUANTITY AND TYPE of PACKING PACKING AUTHORIZATION UN or ID NO. PROPER SHIPPING CLASS or DIVISION PACKIN G ADDITIONAL HANDLING EMERGENCY TELEPHONE NUMBER: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked, and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations.

2 I declare that all of the applicable air transport requirements have been met. SIGNATUR (see warning above) PLACE AND NAME/TITLE OF AMC IMT 1033, 20050204, V1 ---------------------------------------- --------Download any FedForm (free, fillable, savable in Adobe Reader)! Start with the "Flash Demo" at the top of the following page: Convert any fillable PDF form to savable (locally, in Adobe Reader): Convert any document (in any format) to PDF fillable and savable: All (10's of 1,000's) Federal Forms already fillable, savable: About the ITAOP/savePDF Method The traditional Field-by-Field creation process is extremely ineffective and slow. The only realistic option to create high-quality forms is the Insert-Text-Anywhere-on-Page (ITAOP) method. The field creation process is about 10,000 times faster than the traditional method; the list of ITAOP features is not even available for the traditional method.

3 ITAOP savePDF method proved to be very simple and completely reliable for millions of users all over the world (incl. individuals, companies, organizations, government employees). SHIPPER'S CHECKLIST (TO BE USED IN CONJUNCTION WITH AFMAN24-204(I), ATTACHMENT 2) "WASTE" IF MEETING A DEFINITION 1. - SHIPPER'S DECLARATION 4. - PACKAGING- OUTER 5. - MARKING THREE ORIGINAL DOCUMENTS (TWO FOR MOBILITY) "INHALATION HAZARD - (AND ZONE)" SHIPPERS ADDRESS AND PHONE NUMBER USE OF OVERPACKS IDENTIFIED ("OVERPACK USED") TCN AIRCRAFT LIMITATIONS IDENTIFIED AIRPORT DEPARTURE SERVICEABLE (NO DAMAGE THAT WOULD ALLOW LOSS OF CONTENTS) AIRPORT DESTINATION SHIPMENT TYPE UN SPECIFICATION OUTER CONTAINER PACKAGING USED AND CLOSED IAW CORRECT ERN FOR COMMODITY DoD POP PROGRAM NAME AND TITLE OF PREPARER MANUFACTURER'S SUPPLIED METHOD OR REPORT SPI SINGLE PACKAGING (FOR LIQUIDS)MEETS PRESSURE REQUIREMENTS PLACE AND DATE CERTIFIED ULLAGE (FOR LIQUIDS) SIGNATURE PSN AND UN/ID NUMBER PEN/INK CHANGES SIGNED UN/ID NUMBER PSN CLASS/DIVISION (SUBSIDIARY RISK, IF APPLICABLE)

4 PACKING GROUP, IF APPLICABLE NUMBER AND TYPE OF PACKAGES NET QUANTITY PER PACKAGE IN METRIC (UNLESS OTHER MEASUREMENTS AUTHORIZED) NET QUANTITY OF EXPLOSIVES (CLASS 1) IDENTIFIES OF PACKAGE OR PALLET IN METRIC RADIOACTIVE ONLY ACTIVITY PER PACKAGE GIVEN IN BECQUERELS NAME AND SYMBOL OF MATERIAL MATERIAL PHYSICAL AND CHEMICAL FORM PRIMARY RISK 2. - CARGO IDENTIFICATION IF APPLICABLE SUBSIDIARY RISK (IF APPLICABLE) "CARGO AIRCRAFT ONLY" (IF APPLICABLE) CATEGORY OF PACKAGE TRANSPORT INDEX PACKAGING PARAGRAPH FROM ATTACHMENT 5-13 OR 27 OTHER PACKAGING REFERENCE USED COE (COPY PROVIDED) CAA (COPY PROVIDED) WAIVER (COPY PROVIDED) 49 CFR ACID PROOF LINERS USED FOR WELL-CELL BATTERIES IATA/ACAO 6. - LABELING ABSORBENT MATERIAL USED IAW ATTACHMENT 20 OR WHEN DIRECTED BY PACKAGING DIRECTIVE EXEMPTION (COPY PROVIDED) PSN (ADDITIONAL INFORMATION, AS REQUIRED) TECHNICAL NAME RECEPTACLES/PACKAGES, CONTAINING LIQUIDS, ORIENTATED IN UPRIGHT POSITION "RQ" USED TO IDENTIFY A HAZARDOUS SUBSTANCE PACKAGES MEETING LIMITED QUANTITY CRYOGENIC VENTING REQUIREMENTS SECONDARY HAZARDS IDENTIFIED BY PSN, CLASS/DIVISION, NET QUANTITY HANDLING INSTRUCTIONS INSIDE RECEPTACLES/PACKAGES, CONTAINING LIQUIDS, VERIFIED AS MEETING "AIR ELIGIBLE" TEST PRESSURE REQUIREMENTS SECONDARY CLOSURES USED PACKAGING WAIVER 3.

5 - PACKAGING-INNER (COMBINATION PACKAGES) LEAK PROOF LINERS USED "ORIENTATION" ARROWS "LIMITED QUANTITY" OVERPACKS IDENTIFIED IF APPLICABLE "AIR ELIGIBLE" OR SYMBOL FOR COMBINATION "RQ" OR "WASTE" IN ASSOCIATION WITH PSN "INHALATION HAZARD" (IF NOT PART LABEL) DOT-E, COE, AND CAA (IF REQUIRED) NUMBER FLASHPOINT STRONG OUTSIDE CONTAINER USED (WHEN AUTHORIZED) UN AMC IMT 1033, 20050204, V1