Fillable Dd Form 2776 - Dangerous Cargo Load List printable pdf download

Dd Form 2776 - Dangerous Cargo Load List

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2. PAGE

1. EMERGENCY RESPONSE NUMBERS:

DANGEROUS CARGO LOAD LIST

1-800-851-8061

DLA - GEN HAZMAT

(Prescribed by DoD Reg. 4500.9-R)

(703)697-0218/0219

AOC - AMMO/EXPLOSIVES

PAGES

3. FROM

4. VESSEL

b. AGENCY ADDRESS (Include ZIP Code)

a. AGENCY NAME

a. NAME

b. NUMBER

c. REGISTRY

s. IRCS

5. VOYAGE NUMBER

6. VAN NUMBER

7. TOTAL NET EXPLOSIVE WEIGHT:

8. PORT OF ENTRY

9. PORT OF DESTINATION

10. PREPARED IN ACCORDANCE

WITH

KGS

(Lbs)

49 CFR

IMDGC

19. WEIGHT:

20. CUBE: M(3)

14. HAZARD CLASS

15. UN NBR

16. PKG GROUP

17. TYPE PACK

18. PIECES

13. PROPER SHIPPING NAME

KGS (Lbs)

(Ft(3))

11. TRANSPORTATION

12. STOW

(RQ, Waste, Marine

CONTROL NUMBER

LOCATION

Pollutant if applicable)

21. NET EXPL. WT.:

22. REMARKS (Flash Point, Ex No., Dangerous When Wet, Poison Inhalation Hazard)

KGS (Lbs)

14a.

15a.

16a.

17a.

18a.

19a.

20a.

21a.

22a. REMARKS

14b.

15b.

16b.

17b.

18b.

19b.

20b.

21b.

22b. REMARKS

14c.

15c.

16c.

17c.

18c.

19c.

20c.

21c.

22c. REMARKS

14d.

15d.

16d.

17d.

18d.

19d.

20d.

21d.

22d. REMARKS

23. I hereby declare the contents of this consignment are fully and accurately described above by proper shipping name, are classified, packed, marked/labeled, and are in all respects in

proper condition for transport by water according to applicable international and national government regulations.

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE

c. SIGNATURE

d. DATE (YYYYMMDD)

e. REMARKS

24. This is to certify that the cargo inside this unit (Vehicle or Container

) has been properly packed and secured, and that all applicable

transport requirements have been met in accordance with the provisions of 12.3.7 (Container) or 17.7.7 (Vehicle), as applicable, of the General Introduction to the IMDG Code.

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE

c. SIGNATURE

d. DATE (YYYYMMDD)

e. REMARKS

DD FORM 2776, SEP 1998

REPLACES MT FORM 225-R, MAR 94, WHICH IS OBSOLETE.

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