On-Board Hazardous Material Manifest

This form will be used when an Omaha Track employee is transporting Hazardous Materials required to perform their assigned duties. Enter the number and size of containers for all materials that cause the total weight of hazardous materials being carried to exceed the 440 pounds used for Materials of Trade. This Manifest must be returned to Corporate after use and retained for 24 months.

Date*
MM slash DD slash YYYY
Operator Email*
Carrier Number*
US DoT #*
Vehicle #*
Number of Units & Container Type
HM
Basic Description
(Identification Number, Proper Shipping Name, Hazard Class, packing Group)
Weight
(Subject to Change)
Number of Units & Container Type (if needed)
HM (if needed)
Basic Description (if needed)

(Identification Number, Proper Shipping Name, Hazard Class, Packing Group)
Weight (if needed)

(Subject to Change)
Signature*
I hereby certify the Hazardous Materials contained in this vehicle are fully and accurately described above by the proper shipping name and are classified, packaged, marked, and labeled, and in proper condition for transportation according to applicable regulations of the Department of Transportation.
Emergency Contact
Hazmat Service Emergency Number: 800-373-7542 International Shipments: +1-484-951-2432

On-Board Hazardous Material Manifest

Emergency Contact