## U.S. DEPARTMENT OF TRANSPORTATION OFFICE OF HEARINGS

WASHINGTON, D.C. 

## lDJ?

IN THE MATTER OF:

COASTAL AIR TRANSPORT, INC. Respondent. FAA Docket No. FAA-2011-1005 Judge J.E. Sullivan

FAA CASE NO. 2010S0700037

COMPLAINANT'S FINAL WITNESS AND EXHIBIT LIST



## The Complainant, by and through his undersigned attorney, hereby submits in accordance with the Administrative Judge's Order dated July 31, 2012, the Complainant's Final Witness and Exhibit lists as follows:



## I. Agency Witness List

The following individuals are potential witnesses but may not all be called to testify:
1. 

## Juan Bulted Special Agent Federal Aviation Administration Security & 

## Hazardous Materials Safety Joint Security & 

## Hazardous Materials, East FAA San Juan Radar/COMM SSC 5000 Carr 190 Carolina, PR 00979

Mr. Bulted is a Special Agent with the Federal Aviation Administration in San Juan, PR. Mr. Bulted is expected to testify, including but not limited to his knowledge regarding the investigation 'he conducted into the undeclared shipment transported by Respondent on or about October 21, 2009. Mr. Bulted is also expected to testify regarding the sanction proposed in this matter for the undeclared shipment.



## 1

## 2. Cartice Dye Manager, Atlanta Field Office Federal Aviation Administration Security & 

## Hazardous Materials Safety Joint Security & Hazardous Materials, East 1701 Columbia Avenue College Park, GA 30337

Ms. Dye is the Manager of the Atlanta Field Office of the FAA Security and Hazardous Materials Division, College Park Georgia. Ms. Dye is expected to testify, including but not limited to her knowledge regarding the sanction proposed in this matter for the undeclared shipment. Ms. Dye will be proferred as an expert witness. Her Curriculum Vitae will be forwarded under separate cover.
3. Renael Steele CBPO U.S. Customs and Border Protection Henry E. Rohlsen Airport RR#2-9922 Kingshill, St. Croix, VI 00850-9702

Mr. Steel is a Customs Agent with the U.S. Customs and Border Protection in St. Croix, V.I. Mr. Steele is expected to testify, including but not limited to his knowledge regarding the discovery of undeclared shipment of hazardous materials transported by Respondent on or about October 21, 2009.

4. Omar Arroyo Agriculture Specialist U.S. Department ofAgriculture Henry E. Rohlsen Airport RR#2-9922 Kingshill, St. Croix, VI 00850-9702

Mr. Arroyo is an Agriculture Specialist with the U.S. Department ofAgriculture in St. Croix, V.I. Mr. Arroyo is expected to testify, including but not limited to his knowledge regarding the discovery of undeclared shipment of hazardous materials transported by Respondent on or about October 21, 2009.



## 2

## 5. Preston Tutein CBP Supervisory Officer U.S. Customs and Border Protection Henry E. Rohlsen Airport RR#2-9922 Kingshill, St. Croix, VI 00850-9702

Mr. Tutein is a Supervisory Customs Agent with the U.S. Customs and Border Protection in St. Croix, V.I. Mr. Tuitein is expected to testify, including but not limited to his knowledge regarding the discovery of undeclared shipment of hazardous materials transported by Respondent on or about October 21,. 2009. Mr. Tuitein is also expected to authenticate photographs taken ofthe undeclared shipment ofhazardous materials on or about October 21, 2009.

6. Joaquin Puntonet Aviation Safety Inspector FAA San Juan FSD0-63 La Torre de Plaza Las Americas 525 F.D. Roosevelt Ave. San Juan, PR 00918

Mr. Puntonet is an Aviation Safety Inspector with the Federal Aviation Administration in San Juan, PR. Mr. Puntonet is also the Principal Operations Inspector for Coastal Air Transport. Mr. Puntonet is expected to testify, including but not limited to his knowledge regarding Respondent's classification as a will-not-carry hazardous materials air carrier. Complainant also reserves the right to supplement this list with additional witnesses as they become identified and to call other witnesses for purposes ofimpeachment or rebuttal and to call any witnesses listed on Respondent's witness list.



## II. Exhibit List

The Complainant may proffer documents contained in Enforcement Investigative Report ("EIR") 2010S0000037 including, but not limited to, the other documents identified below. Copies of the following identified exhibits are attached to this prehearing submission and have been provided to the Administrative Judge and Respondent.

C-1 Letter dated December 11, 2009 from Juan Bulted, FAA Special Agent to Michael W. Foster, President, Coastal Air Transport

C-2 U.S. States Certified Mail Receipt for article number 7008 1830 0000 5608 4635

C-3 Letter dated January 14, 2010 from Michael W. Foster, President Coastal Air Transport to Juan Bulted

3

## C-4 Material Safety Data Sheet (MSDS) for Diesel Fuel

C-5 Bill ofLading dated October 21, 2009 signed by Coastal Air Transport (Mike Foster)

C-6 49 C.F.R. §172.101 Hazardous Materials Table entry for Diesel Fuel and Fuel Oil

C-7 Memorandum dated November 2, 2009 from SCBPO Preston Tutein, U.S. Customs and Border Protection to FAA Hazmat Coordinator Juan Boulted, regarding Detention ofFuel Oil

C-8 Photographs of shipment transported by Coastal Air Transport on or about October 21, 2009 (9 photographs, identified as C-8a, C-8b, C-8c, etc.)

C-9 FAA National Operations and Training Manual for the Non-Acceptance and Nontransportation ofDangerous Goods in Air Transportation for Coastal Air Transport dated December 1999.

C-10 Shipper's Declaration ofDangerous Goods (example)

C-11 49 C.F.R. §172.312 Liquid hazardous materials package orientation label

C-12 49 C.F.R. §172.419 Flammable Liquid label Complainant also reserves the right to list additional exhibits, as they become known and to introduce other exhibits for purposes ofimpeachment or rebuttal.

Respectfully submitted this 5th 

## day ofDecember 2012.

omey Office ofthe Regional· Counsel



## 4

## CERTIFICATE OF SERVICE



## I hereby certify that a copy ofthe foregoing Agency Final Witness and Exhibit Lists was mailed by Federal Express and facsimile to:
The Honorable J.E. Sullivan DOT, Administrative Law Judge Office ofHearings, M-20 U.S. Department ofTransportation 1200 New Jersey Avenue, S.E. East Building Ground Floor Room E12-320 Washington, D.C. 20590 (FAX) (202) 366-7536
and via Express Mail to:
Michael Foster, President Coastal Air Transport, Inc. P.O. Box 3985 Christiansted, St. Croix, VI 00822
and the original and one copy via Federal Express to: Hearing Docket U.S. Department ofTransportation Docket Operations, M-30 West Building Ground Floor Room W12-140 1200 New Jersey Avenue, S.E. Washington, D.C. 20590



# DEC 0 5 

# 2012 Dated

5

## cc:**~** 

## AS0-7:RRG: 12/4/12 F:\Attomey\RRG\hearings\Hazmat\Coastal Air Transport-201 080700037\agency final witness list.doc

6

## December 11, 2009 FEDERAL AVIATION ADMINISTRATION Aviation Security and Hazardous Materials P.O. Box 38092 Airport Station San Juan, PR. 00937-1092

Registered Mail Return-Receipt Requested
File Number: 2010S0700037

Mr. Michael W. Foster President, Coastal Air Transport, Incorporated P 0 Box 3985 Christiansted, Saint Croix USVI 00822

Dear Sir:
The Federal Aviation Administration (FAA) is conducting an investigation concerning the apparent failure ofCoastal Air Transport, Incorporated to comply with the provisions ofTitle 49, Code ofFederal Regulations (49 CFR).
On October 21, 2009, at approximately 1535 hours, at the Alexander Hamilton Airport (STX), Saint Croix, U.S. Virgin Islands, an Inspector ofthe U.S. Customs and Border Protection inspected the Coastal Air Transport aircraft servicing flight number #413. The inspection revealed that you were the pilot in command. The inspection also revealed that you accepted and transported in air commerce an un-marked and un-manifested box which contained two plastic bags marked Hazmatpac, each containing two bottles. Each bottle was labeled Fuel Oil, UN1993 and contained approximately 750 mi. The shipper
was identified as SGS Saint Eustatius.
The hazardous materials were not declared, described, packaged, marked, labeled, and in condition for air transportation as required by the hazardous materials regulation. Additionally; Coastal Air Transport, Incorporated is not a certified hazardous material carrier.

The FAA would like to provide you with an opportunity to furnish any information concerning this matter which may reflect mitigating circumstances.

As a part ofour investigation, we are requesting the following related information:



# EXHJBrr

__ 

# l.......__

### 1- A copy ofthe appropriate material safety data sheet(s) (MSDS) for dangerous goods offered in this shipment. The MSDS must show the proper shipping name, Class number, UN Number, Packing Group, and packing instructions for the item described above.

2- Copies ofthe air waybill(s), shipper's pick up record and other relevant documents associated with the shipment in question.

3- A copy ofthe hazardous materials training records for each individual involved in the transportation ofthis shipment.

4- A copy ofyour hazardous materials training curriculum.

5- A description ofactions implemented to prevent further incidents ofthis type from occurrmg.
6- Any additional documentation or information you feel to be pertinent to this investigation.
Please be advised that the allegations contained herein do not necessarily include all the deficiencies that may be subsequently discovered during the course ofthis investigation.

This office should receive your response, ifany, within ten (1 0) business days from your receipt ofthis letter. Ifno response is received at that time, our report will be processed without the benefit ofyour information. Your reply may be sent email to Juan.Bulted@faa.gov.

Sincerely,**~** 

## ?ledtd Juan Bulted Special Agent

## • SENDER: COMPLETE THIS SfCTION

• Complete Items 1, 2, and 3. Also complete ( Item 4 If Restricted Delivery Is desired.

• Print your name and address on the reverse ' so that'we can return the card to you.

• Attach this card to the back of the mallplece,

or on the front If space permits.
1. Article Addressed to: 0. Is delivery different from Item 1? If YES: 'enter delivery address below:



## 7008 1830 DODO 5608 4635 PS Form 

### 3811, February 2004 Oomesttc Return Receipt



## U.S. Postal Servicer·., · D ExplllSS Mall D Return Receipt for Merchandise 

## Dc.o.o. (Extra Fee) D**10259~-M-1540**



## CERTIFIED MAIL,-' 'RECEIPT

. (Domestic Mail Only; No Insurance Coverage Provided)

# ~iG;.;.;.;;.;;~.ii·i·~~~~iiii~~~·~·~ll~ ::r 

# OFFICIA USE**~L_~~~~~~~~~=-=-~~**

## ~ Postage

## h-**~~~-i** U1 

# E: Return Receipt CJ (Endolsement Req CJ Restrlcllld OelivelyReqI (Endorsement u CJ 

### rn Postmark Here

# ~~~----~=;;=~~--------------,**~** CJ CJ ('-



# 1 EXHIBIT..,..

._....,..__ _' 

# /// 

# CoaJtal

# olir ·uranJport

# ~uanBulted South Florida FSD0-19 San Juan Security Field Unit 525 FD Roosevelt Ave, Suite 901 San Juan, Puerto Rico 00918-1198

File Number: 2010$0700037

January 14, 2010

Dear Sir,

In response to your letter received January 4, 2010, we offer the following as requested:



### 1. A copy of the Material Safety Data Sheet(MSDS) for low sulfur diesel fuel (7 pages). 2. Copies of the Bill of lading from the shipper. Copies of our Cargo Manifest were held by U.S. Customs in St Croix. These items were correctly listed as oil samples. 3. Copies of the hazardous materials training records for those involved in shipping these samples. 4. We were advised years ago by our Principal Operations Inspector (POl), that a hazardous material program was not recommended and would not be required to transport small quantities of properly packaged flammable materials. These materials include butane lighters, matches, six packs of spirits, mouthwash, aftershave, etc. The material and quantities in this shipment fall into this category. 5. The shipper has offered us the use of their lATA Training Program. We have agreed to have all appropriate personnel complete this course. 6. Samples were shipped in limited Quantity(less than 10l for Diesel Fuel) as per lATA DG Regs 2.8.2.1(b) and packaged in a suitable box and materials for shipment. Shipment was placed in a cargo compartment not accessible to passengers. Included are labels attached to these samples describing their content. These were apparently not noticed during the customs inspection.

Coastal Air has operated for almost 30 years, accident, incident, and violation free. We have agreed to add additional training in the future and request that this investigation be closed with no further action being taken.

# :Jj~ Michael W. Foster President

# EXHIBIT.--~-- FAA/Smlth Florida FSD0-19 Sim i1.11ih 

### radllty

P.O. BOX 3985 • CHRISTIANSTED, U.S.V.I. 00822 • TELEPHONE (340) 773-6862 

# 7 0 

# p 

# 7

# HOVENSA NFPA 704 (Section 16) 

### MATERIAL SAFETY DATA SHEET 

### Low Sulfur Diesel Fuel MSDS No. 1797 

# !1. CHEMICAL PRODUCT and COMPANY INFORMATION (rev. Jan-99) HOVENSA l.LC. 1 Estate Hope Christiansted, VI 00820-5652 EMERGENCY TELEPHONE NUMBER (24 hrs): CHEMTREC (800) 424-3000 COMPANY CONTACT (business hours): HOVENSA Safety Department (340) 692-3000
SYNONYMS: Diesel Fuel #2; Hess Premium Diesel; Low Sulfur Diesel; Motor Vehicle Diesel Fuel See Section 

### 16 for abbreviations and acronyms. 12 I

. COMPOSITION and INFORMATION ON INGREDIENTS (rev. Jan-99)

INGREDIENT NAME Diesel Fuel CAS NUMBER: 68476-34-6 Naphthalene CAS NUMBER: 91·20-3 EXPOSURE LIMITS OSHA PEL-TWA: 5 mgtm. as mineral oil mist ACGIH TLV-TWA: 1997 NOIC- 100 mgtm 3

, skin. A3 OSHA PEL: ACGIH TLV-TWAISTEL: 10ppm 10/15ppm,M A complex mixture of hydrocarbons with carbon numbers in the range C9 and higher. Fuel contains 

### a multifunctional additive. 

# I 3. HAZARDS IDENTIFICATION {rev. Jan-99; Tox-98)

EMERGENCY OVERVIEW CAUTION! CONCENTRATION P!:RCENT BY WEIGHT 100
Typically < 0.01

Premium Diesel

OSHA/NFPA COMBUSTIBLE LIQUID- SLIGHT TO MODERATE IRRITANT· EFFECTS CENTRAL NERVOUS SYSTEM -HARMFUL OR FATAL IF SWALLOWED Moderate fire hazard. Avoid breathing vapors or mists. May cause dizziness and drowsiness

.. May cause moderate eye irritation and skin irritation (rash). Long-term, repeated exposure may cause skin cancer. If ingested. do NOT induce vomiting, 

### as this may cause chemical pneumonia (fluid in the lungs). 

## EYES Contact with liquid or vapor may cause mild irritation. 

### §.!Slli May cause skin irritation with prolonged or repeated contact. Practically non-toxic if absorbed following acute (single) exposure. Liquid may be absorbed through the skin in toxic amounts if large areas of skin are repeatedly exposed. INGESTION The major health threat of ingestion occurs from the danger of aspiration (breathing) of liquid drops into the lungs, particularty from vomiting. Aspiration may result in chemical pneumonia (fluid in the lungs), severe lung damage, respiratory failure and even death. Ingestion may cause gastrointestinal disturbances, including irritation, nausea, vomiting and diarrtlea, and central nervous system (brain) effects similar to alcohol intoxication. In severe cases, tremors, convulsions, loss of consciousness. coma, respiratory arrest, and death may occur. INHALATION Excessive exposure may cause irritations to the nose, throat, lungs and respiratory tract. Central nervous system (brain) effects 

### may include headache, dizziness, loss 

### of balance and. coordination. unconsciousness, coma, respiratory failure, and death.

Revision Date: 02/28/01

# EXHIBIT._...,.J~.___- Page 1 of7 

# :ro P 

# g

# HOVEN

# SA
MATERIAL SAFETY DATA SHEET Low Sulfur Diesel Fuel MSDS No. 

### 1797

WARNING: the burning of any hydrocarbon as a fuel in an area without adequate ventilation may result in hazardous levels of combustion products, including carbon monoxide. and inadequate oxygen levels, which may cause unconsciousness. suffocation, and death. CHRONIC EFFECTS and CARCINOGENICITY Similar products produced skin cancer and systemic toxicity in labOratory animals following repeated applications. The significance of these results to human exposures has not been determined- see Section 

### 11 Toxicological Information. IARC classifies whole diesel fuel exhaust particulates as probably carcinogenic to humans (Group 2A). NIOSH regards whole diesel fuel exhaust particulates as a potential cause of occupational lung cancer based on animal studies and limited evidence in humans. MEDICAL CONDITIONS AGGRAVATED BY EXPOSURE lnitation from skin exposure may aggravate existing open wounds, skin disorders, and dermatitis (rash). ( 4. FIRST AID MEASURES (rev. Jan-98; Tox-98)

EYES In case of contact with eyes, immediately flush with clean, low-pressure water for at least 15 min. Hold eyelids open to ensure adequate flushing. Seek medical attention. SKIN Remove contaminated clothing. Wash contaminated areas thoroughly with soap and water or waterless hand cleanser. Obtain medical attention if irritation or redness develops. INGESTION DO NOT INDUCE VOMITING. Do not give liquids. Obtain immediate medical attention. If spontaneous vomiting occurs. lean victim forward to reduce the risk of aspiration. Monitor for breathing difficulties. Small amounts of material which enter the mouth should be rinsed out until the taste is dissipated. INHALATION Remove person to fresh air. If person is not breathing provide artificial respiration. If necessary, provide additional oxygen once breathing is restored if trained to do so. Seek medical attention immediately. 

# I 5. FIRE FIGHTING MEASURES (rev. Oct-96)

FLAMMABLE PROPERTIES: FLASH POINT: AUTOIGNITION POINT: OSHAINFPA FLAMMABILITY CLASS: LOWER EXPLOSIVE LIMIT(%): UPPER EXPLOSIVE LIMIT (%): FIRE AND EXPLOSION HAZARDS > 125 °F (>52 

### iC) minimum 

### 494 °F (257 

### °C) 2 (COMBUSTIBLE) 

### 0.6 7.5 PMCC

Vapors may 

### be ignited rapidly when exposed to heat. spark. open flame or other source of ignition. When mixed 

### With air and exposed to an ignition source, flammable vapors can bum in 

### the open or explode in confined spaces. Being heavier than air, vapors may travel long distances to an ignition source and flash back. Runoff to sewer may cause fire or explosion hazard. EXTINGUISHING MEDIA SMALL FIRES: 

### Anyextinguisher suitable for Class B fires, dry chemical. C02, water spray, fire ftghting 

### foam, or Halon. LARGE FIRES: Water spray, 

### fog or fire fighting foam. Water 

### may be ineffective for fighting the fire, but may 

### be used to cool fire-exposed containers. · FIRE FIGHTING INSTRUCTIONS

Revision Date: 02128/01 Page 2 of7

# HOVENSA

MATERIAL SAFETY DATA SHEET 

### Low Sulfur Diesel Fuel MSDS No. 1797
Small fires in the incipient (beginning) stage may typically be extinguished using handheld portable fire extinguishers and other fire fighting equipment. Firefighting activities that may result in potential exposure to high heat, smoke or toxic by-products of combustion should require NIOSH/MSHA- approved pressure-demand self-contained breathing apparatus with full facepiece and full protective clothing. Isolate area around container involved in fire. Cool tanks, shells, and containers exposed to fire and excessive heat with water. For massive fires the use of unmanned hose holders or monitor nozzles may 

### be advantageous to further minimize personnel exposure. Major fires may require withdrawal, allowing the tank to bum. Large storage tank fires typically require specially trained personnel and equipment to extinguish the fire, often including the need for properly applied fire fighting foam. See Section 16 for the NFPA 704 Hazard Rating. 

# I 6. ACCIDENTAL RELEASE MEASURES (rev. Jan-98}

ACTIVATE FACILITY'S SPILL CONTINGENCY OR EMERGENCY RESPONSE PLAN. Evacuate nonessential personnel and remove or secure all ignition sources. Consider wind direction: stay upwind and uphill, if possible. Evaluate the direction of product travel, diking, sewers, etc. to confinn spill areas. Spills may infiltrate subsurface soil and groundwater; professional assistance may be necessary to determine the extent of subsurface impact. Carefully contain and stop the source of the spill, if safe to do so. Protect bodies of water by diking, absorbents, or absorbent boom, if possible. 

### Do not flush down sewer or drainage systems, unless system is designed and pennitted to handle such material. The use of fire ftghting foam 

### may be useful in certain situations to reduce vapors. The proper use of water spray may effectively disperse product vapors 

## or the liquid itself, preventing contact with ignition sources or areas/equipment that require protection. Take up with sand or other oil absorbing materials. Carefully shovel, scoop or sweep up into a waste container for reclamation or disposal- caution, flammable vapors may accumulate in closed containers. Response and dean-up crews must be properly trained and must utilize proper protective equipment (see Section 8). 

### J 7. HANDLING and STORAGE (rev. Jan-98)

HANDLING PRECAUTIONS Handle as a combustible liquid. Keep away from heat, sparks, and open flame! Electrical equipment should be approved for classified area. Bond and ground containers during product transfer to reduce 

### the possibility of static-initiated fire or explosion. Special slow load procedures for "switch loading" must be followed to avoid the static ignition hazard that can exist when higher flash point material (such as fuel oil) is loaded into tanks previously containing low flash point products (such as this product)

- see API Publication 2003, "Protection Against Ignitions Arising Out Of Static, Lightning and Stray Currents. STOBAGEPRECAUTIONS Keep away from flame, sparks, excessive temperatures and open flame. Use approved vented containers. Keep containers closed and clearly labeled. Empty product containers or vessels may contain explosive vapors. 

### Do not pressurize, cut, heat, weld or expose such containers to sources of ignition. Store in a well-ventilated area. This storage area should comply with NFPA 30 "Flammable and Combustible Liquid Code". Avoid storage near incompatible materials. The cleaning of tanks previously containing this product should follow API Recommended Practice (RP) 2013 "Cleaning Mobile Tanks In Rammable and Combustible Liquid Service" and API RP 

### 2015 "Oeaning Petroleum Storage Tanks". WORK/HYGIENIC PRACTICES

Revision Date: 

### OV28/01 Page 3 of7**~------~~~~~~~~~~-------------------------.** 

# HOVENSA
MATERIAL SAFETY DATA SHEET Low Sulfur Diesel Fuel MSDS No. 1797
Emergency eye wash capability should be available in the near proximity to operations presenting a potential splash exposure. Use good personal hygiene practices. Avoid repeated and/or prolonged skin exposure. Wash hands before eating, drinking, smoking, or using toilet facilities. Do not use as a cleaning solvent on the skin. Do not use solvents or harsh abrasive skin cleaners for washing this product from exposed skin areas. Waterless hand cleaners are effective. Promptly remove contaminated clothing and launder before reuse. Use care when laundering to prevent the formation 

### of flammable vapors which could ignite via washer or dryer. Consider the need to discard contaminated leather shoes and gloves. 

# I 8. EXPOSURE CONTROLS and PERSONAL PROTECTION (rev. Jan-98)

ENGINEERING CONTROLS Use adequate ventilation to keep vapor concentrations of this product below occupational exposure and flammability limits, particularly in confined spaces. f;YEIFACE PROTECTION Safety glasses or goggles are recommended where there is a possibility of splashing or spraying. SKIN PROTECTION Gloves constructed of nitrile, neoprene, or PVC are recommended. Chemical protective clothing such as of E.l. DuPont TyChem®, Saranex® or equivalent recommended based on degree of exposure. Note: The resistance of specific material may vary from product to product as well as with degree of exposure. Consult manufacturer specifications for further information. RESPIRATORY PROTECTION A NIOSH/MSHA-approved air-purifying respirator with organic vapor cartridges or canister may be permissible under certain circumstances where airborne concentrations are or may ba expected to exceed exposur411lmits or 

### for odor or lilitatlon. Protection**provid~d** 

### by air-purifying 

### rnspirators is limited.**Ref~** 

### to OSHA 

### 29 CFR 

### 1910.134, ANSI 

### Z88.2-1992, NIOSH Respirator Decision Logic, and the manufacturer.for additional guidance on respiratory protection selection. Use 

### a positive pressure, air-supplied respirator 

### if there is 

### a potential for uncontrolled release, exposure levels are not known. in oxygen-deficient atmospheres, or any other circumstance where an air-purifying respirator may not provide adequate protection. 

# I 9. PHYSICAL and CHEMICAL PROPERTIES (rev. Jan-94)

APPEARANCE Clear, straw-yellow liquid ODOR Mild, petroleum distillate odor BASIC PHYSICAL PROPERTIES BOILING RANGE: 320 to 690 °F (160 to 366 °C) VAPOR PRESSURE: 0.009 psia 

### @ 70 °F (21 °C) VAPOR DENSITY (air 

# =1): > 

### 1.0 SPECIFIC GRAVITY (H 2

### 0::: 1): 0.83 to 0.86@ 60 °F (16 °C) PERCENT VOLATILES: 

### 100 o/o EVAPORATION RATE: SOLUBILITY**(H~):** Slow; varies with conditions Negligible



### !10. STABILITY 

### and REACTIVITY (rev. 

### Jan-94)

STABILITY: Stable. Hazardous polymerization 

### will not occur. CONDITIONS TO AVOID and INCOMPATIBLE MATERIALS

Revision Date: 02/28/01 

### Page 4 of 

### 7

# HOVEN

# SA

MATERIAL SAFETY DATA SHEET 

### Low Sulfur Diesel 

### Fuel MSDS No. 1797

Avoid high temperatures. open flames, sparks, welding, smoking and other ignition sources. Keep away from strong oxidizers; Viton 

### ® ; Fluorel 

### ® HAZARDOUS DECOMPOSITION PRODUCTS Carbon monoxide. carbon dioxide and non-combusted hydrocarbons (smoke}. 

# I 11. TOXICOLOGICAL PROPERTIES (rev. Jan-98; Tox-98)

ACUTE TOXICITY Acute dennall050 (rabbits): > 

### 5 ml/kg Acute oral LD50 (rats): 

### 9 ml/kg Primary dermal irritation: extremely irritating (rabbits) Guinea pig sensitization: negative Draize eye irritation: non-irritating (rabbits)

CHRONIC EFFECTS AND CARCINOGENICITY Carcinogenic OSHA: NO l.ARC: NO NTP: NO ACGIH: 1997 NOIC A3 Studies have shown that similar products produce skin tumors In laboratory animals following repeated applications without washing 

### or removal. The significance of this finding to human exposure has not been determined. Other studies with active skin carcinogens have shown that washing the animal's skin with soap and water between applications reduced tumor formation. MUTAGENICITY (genetic effects) This material has been positive in a mutagenicity study. 

### j12. ECOLOGICAL INFORMATION {rev. Jan-98)

Keep out of sewers, drainage areas, and waterways. Report spills and releases, as applicable, under Federal and State regulations. 

### 113. DISPOSAL CONSIDERATIONS {rev. Jan-98)

Consult federal. state and focal waste regulations to determine appropriate disposal options. 

### 114. TRANSPORTATION INFORMATION {rev. Jan-98)

PROPER SHIPPING NAME: Diesel Fuel HAZARD CLASS and PACKING GROUP: 3. PG Ill DOT IDENTIFICATION NUMBER: 

### NA 1993 DOT SHIPPING 

### LABEL: None 

### j15. REGULATORY INFORMATION (rev. Feb-01)

U.S. FEDERAL, STATE, and LOCAL REGULATORY INFORMATION This product and its constituents listed herein are on the EPA TSCA Inventory. Any spill or uncontrolled release of this product. inqluding any substantial threat of release. 

### may be subject to federal, state and/or local reporting requirements. This prOduct and/or Its constituents may also be subject to other regulations at the state and/or !ocallevel. Consult those regulations applicable to your facility/operation. CLEAN WATER ACT COIL SPILLS) Any spill or release ofthis product to "navigable waters" (essentially any surface water, including certain wetlands) or adjoining shorelines suffiCient to cause a visible sheen or deposit 

### of a sludge or emulsion must 

### be reported immediately to the National Response Center 

### (1-800-424-8802) or, 

### if not practical, the U.S. Coast Guard with follow-up to the National Response Center, as required by U.S. Federal Law. Afso contact appropriate state and local regulatory 

### agencies as required. CERCLA SECTION 103 and SARA SECTION 304 (RELEASE TO THE ENVIRONMENT) The CERCLA defrnition of hazardous substances contains 

### a "petroleum exc/ustori" dause 

### which exempts crude oil, refined, and unrefined petroleum products and any indigenous components of such. However, other federal reporting requirements {e.g., SARA Section 304 as well as the Clean Water Act 

### if the spHI occurs on navigable waters) may 

### still apply.

Revision Date: 

### 02/28/01 Page 5of 

### 7

# HOVENSA
MATERIAL SAFETY DATA SHEET 

### Low Sulfur Diesel Fuel MSDS No. 1797
SARA SECTION 

### 311/312- HAZARD CLASSES ACUTE HEALTH CHRONIC HEALTH FIRE SUDDEN RELEASE OF PRESSURE REACTIVE 

## X X X SARA SECTION 

### 313- SUPPLIER NOTIFICATION This product may contain listed chemicals below the de minimis levels which therefore are not subject to the supplier notification requirements of Section 313 of the Emergency Planning and Community Right-ToKnow Act (EPCRA) of 1986 and of 40 CFR 372. Ifyou may be required to report releases of chemicals listed in 

### 40 CFR 

### 372.28, you may contact HOVENSA if you require additional information regarding this product. CANADIAN REGULATORY INFORMATION (WHMIS) Class B, Division 3 (Combustible Liquid) and Class 0, Division 2, Subdivision 8 (Toxic by other means) 

### 116. OTHER INFORMATION (rev. Feb--01)

NFPA® HAZARD RATING HEALTH: 

### 0 Negligible FIRE: 

### 2 Moderate REACTIVITY: 0 Negligible
HMIS®HAZARD RATING HEALTH: 1 • Slight FIRE: 

### 2 Moderate REACTIVITY: 0 Negligible ·Chronic SUPERSEDES MSDS DATED: 01/25/99 ABBREVIATIONS: AP ;:; Approximately < = Less than > "' Greater than N/A = Not Applicable N/D 

### = Not Determined ppm 

### = parts per million ACRONYMS: ACGIH American Conference of Governmental
AIHA ANSI
API Industrial Hygienists American Industrial Hygiene Association American National Standards Institute

. (212) 642-4900

American Petroleum Institute (202} 682-8000 CERCLA Comprehensive Emergency Response,
DOT
EPA HMIS 

### !ARC Compensation, and Liability 

### Act U.S. Department of Transportation [General info: (800) 467-4922] U.S. Environmental Protection Agency Hazardous Materials Information System International Agency For Research On Cancer MSHA Mine Safety and Health Administration NFPA National Fire Protection Association (617}770..3000 NIOSH National Institute of Occupational Safety
NOIC and Health Notice of Intended Change (proposed 

### change to ACGIH TL 

### V)

Revision Date: 02/28/01 NTP OPA OSHA
PEL RCRA
REL SARA 

## SCBA SPCC
STEL
TLV TSCA 

### TWA WEEL
WHMIS National Toxicology Program Oil Pollution Act of 1900 U.S. Occupational Safety & Health Administration Permissible Exposure Limit (OSHA} Resource Conservation and Recovery Act Recommended Exposure Limit (NIOSH) Superfund Amendments and Reauthorization Act of 1986 Title Ill Self-Contained Breathing Apparatus Spill Prevention, Control, and Countermeasures Short-Term Exposure Limit (generally 15 minutes) Threshold Limit Value (ACGIH) Toxic Substances Control 

### Act Time Weighted Average (8 hr.) Workplace Environmental Exposure Level (AIHA} Canadian Workplace Hazardous 

### Materials Information System

Page 6 of7

# HOVENSA

MATERIAL SAFETY DATA SHEET 

### Low Sulfur Diesel Fuel MSDS No. 1797

DISCLAIMER OF EXPRESSED AND IMPUED WARRANTIES Information presented herein has been compiled from sources considered to be dependable, and is accurate and reliable to the best of our knowledge and belief. but is not guaranteed to be so. Since c:onditions of use are t>eyond our control. we make no warranties. expressed or implied, except 1t1ose that may be contained In our written contrad of sale or acknowtedgment. Vendor assumes no responsrbility for injury to vendee or third persons proximately caused by the material if reasonable safety procedures are not adhered to as stipulated In the data sheet. AddltionaHy, vendor assumes no responsibility for Injury to vendee or third persons proximately caused by abnonnaJ use of the material, even If reasonable safety procedures are followed. Fuf"thennore, vendee assumes the risk in their use of the material.



### Revision Date: 02128/0.1 Page7of7_,., •*

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IF NON-HAZARDOUS AND HAZARDOUS MATERIALS ARE LISTED ON THE SAME BILL OF LADING. THE HAZARDOUS 

# I

MATERIALS MUST BE LISTED FIRST OR WRITTEN IN A CLEARLY**CONT~P..,STING** COLOR

• IF APPLICABLE 

# l EMERGENCY {SPILL, LEAK. 

### FIRE, EXPOSURE OR ACCIDENT} 

### 24 HOUR TELEPHONE- CALL CHEMTREC TOLL FREE USA 1-800-424-9300 

# j

This is to certify that the above name.d materials =properly classified, 

### de-sc1 iced,

# pa~kaged.

# "'ll

marked, and labeled and are in proper condition for 

### transportation occording to the applicable 

## 1 . regulations of the 

### Department of Transportation 

# l

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## II CARRIER: 

# (1g7

# -kQ**~~ l.~Lt** **{{}s~J** DATE:

_

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# ========='===---**----========:=.=:;;o:-----:=,~=.:!'** CONSUL f SGS :SAFf:fY PROGRAM 

### SAMPLE LABELING · Section €.4.2 

### & 9.3.6 SAtv1PLE PACK:NG SAMPLE**TR<l.NSPO~T** 

### SAMPLE SHIPP1NG 

### Section 6 4.4 & 

### 9 3 8


### : Sscticn 6.4.4 & 

### '1 3 8



# EXHIBIT. 

# 5Symbols(1)Hazardousmaterialsdescriptionsandpropershippingnames(2)...DFuelcellcartridgesorFuelcellcartridgescontainedinequipmentorFuelcellcartridgespackedwithequipment,COIJ·tainingwater-reactivesubstances.Fueloil(No.I,2,4,5,or6).....00)Fuelsystemcomponents(includingfuelcontrolunits(FCU),carburetors,fuellines,fuelpumps)seeDangerousGoodsinApparatusorDilngerousGoodsinMachinery.Fulminateofmercury(dry).Fulminateofmercury,wet,seeMercuryfulminate,etc.FulminatinggoldFulminatingmercuryFulminatingplatinumFulminatingsilverFulminicacidFumaryl·chlorideFumigatedlading,§§172.302(g),173.9176.76(h).Fumigatedtransportvehicleorfreightcontainersee§173.9.FuraldehydesFuran............FurfurylalcoholFurturylamineFuse,detonating,metalclad,seeCord,detonating,metalclad.Fuse,detonating,.mildeffect,metalclad,seeCord,detonating,mildeffect,metalclad.§172.101HAZARDOUSMATERIALSTABLE-ContinuedIdentiHazardclassorDivisionficationIPGNumbersLabelCodes(3)(4)I(5)(6)4.3IUN34763INA1993ForbiddenForbidctenForbiddenForbiddenForbiddenForbidden8IUN17806.1UN11993UN23896.1UN28743UN25264.311113........./·······III8II6.1,3I3Ill6.1Ill3,8Specialprovisions(§172.102)(7)Exceplions(8A)230.144.81.183.T4.TP1,150TP29......I(8)--Packagin}(§173.···Non-IbulkBulk(88)(8C)230230203242.82,182.T7,TP2154......,202182,T7,TP2153.202243T12,TP2,TP13None.201243.183,T4,TP1153.20324181,183,T4,TP1150.203242.II(9)(10)QuantitylimitationsVessel(see§§173.27andstowage175.75)t---Passengeraircraft!rail{9A)5kg60L1 LairLoca-lionIeraonly{98)I{10A)I50kgA220LA30Lc60LA.30LE220LA60LAIIIOther{108)8,4040(0)...""'J1\)...0'()()-n"'():T-...0I-.....ma.3:0:;:,-

## MEMORANDUM FOR: Hazmat Materials
FROM: CBPO Renael Steele Henry E. Rohlsen Airport, RR #2-9922 Kingshi/1, St. Croix, VI 00850-9702



### Date: 

## November 02, 2009

TO: FAA Hazmat Coordinator Juan Boulted
CC: SCBPO Preston Tutein
SUBJECT: Detention of Fuel Oil

On October 21,2009 at 1535, while inspecting cargo from Coastal Air flight #413, an unmanifested box was found with no identifYing markings. After checking with the four passengers that arrived on the same flight, it was determined that it was cargo. Upon opening the box, two plastic bags were found labeled "Hazmatpac". Upon opening the bags, two bottles approximately 750ml each were found labeled fuel oil UN# 1993 that contained a liquid substance. The contents appeared to be hae:ardous materials. There was no MSDS, no packing slips or any hazardous markings or warnings labeled on box. Unaware ofthe actual contents, CBPO Steele and CBPAS Arroyo questioned Michael Foster, pilot ofCoastal Air about the box and its contents. 

## Mr. Foster stated that it was fuel oil and he brought it in for SGS, a company in St. Croix, USVI. Mr. Foster 

## WaS asked why the box was not manifested and stated that he forgot to put it on the manifest. Mr. Foster then amended the manifest and added the box with the description as samples. SCBPO Tutein was contacted and advised ofthe contents found. As per SCBPO Tutein, the box was detained for further advisement on contents and shipping requirements. The items were detained by CBPO Steele on form 6051 D #617246. The following day, October 22, 2009, SGS faxed CBP a certificate ofanalysis and a bill of lading stating that the samples are diesel fuel UN#l202.



# 1,,.S. DEPARTMENT OF TRANSPORIAII01\. FU>IIt-\1. :\**VIAIIO~** !\D.\IINISTRAIIO\! ('1\11 \VI.\ Ill 1'\ '\I (I 'f<ITY



### Photograph provided by Tutein PRESTON. CBP Supervisory Oflicer, HE::NRY E. ROHLSEN AIRPORT (STX), Saint Croix. USVL Photograph shows the fiberboard box v,;hich contained the shipment 

## of Gas OiL Class 

### 3. UN 

## 1202, PG-IIL Observe the lack of hazmat markings and communication labels.

lntcr\iewediReviewed on**-'-A~p'-'-r.!.!il--'1'-'8'-'-'-=2'-"0'-"1.:::..0** 

## _________. At 

### SJU-SECFU


### B: Special Agent Juan BULTED

FAA Form 1600-32-1 (9-86 l 

### . File No. 

### 20 l050700037

FOR OFFICIAL USE ONLY (Public availabilitv lc1 be dctcrm111c 

# EXHIBIT

_ 

# _.::I

__**..-----~·5** 

# u.s.c. 532), .S. DEPARTMENT OF TRANSPORTATION FEDER,\L :\VIATION :\D!\11NISTRo\ liON CIVIl ·\\'L\TirJ\ <;HTRITY



### Photograph provided by Tutcin PRESTON. CBP Supervisory Officer. liENRY E. 

### ROFILSEN AIRPORT (STX), Saint Croix, USVf. Photograph shows the fiberboard box which contained the shipment ofGas Oil, Class 3, 

### UN!202, PG-fii. Observe the lack ofha;:mat markings and communication labels.

Interviewed/Reviewed on**,_,A~pc:...:ri'-'-1**

## _,_1-"CS_,_.=2("'--).:...1 0"--------- At 

### SJU-S 

## ECFU
By 

### Special Agent Juan BULTED

. File 

### No. 

## 20 IOS0700037

FAA Form 1600-32-1 t9-86) FOR OFFICIAL USE ONLY (l'uhlrc availabdit\**tub~** Jctcrmrn<: 

### under 5 US.C. 5321u.S DEPA.RT.fv1ENTOF TRANSPORTA.Ticn, I·UJI RAL AVI/11"/0,'\ !\DI\IINISTIC\T/()\, CIVIl .\ V/.YlfU.\ S/ U"kll \.



### Photograph provided by Tutein PRESTON, CBP Supervisory Ollicer. HENRY 

## E. ROHLSEN AIRPORT (STX), Saint Croix, USVI. Photograph shows a box and two plastic hags which contained two bottles containing Gas Oil, Class 3. UN 1202, PG-lll.



## ---··-------------------------------. fOP 5-B ----= 

### 1"' "' iewcd/Revicwed on 

## A 

## ril 18, 20 10 At 

### SJ[!-SECFi!

# ~~~~~-----------------

# 3y~al Agent Juan 

## BULTEQ____

_______ File

# No.~------

'AA 

# r.,., 1600-Jl-1 19·86) FOR OFFICIAL USE ONLY**-~----·--**

!Puhlic '" ailanilltl· 1o he (ktenn111e 

### under 5 

### U.Sc 532), S. DFf'ARTMENT OF TRANSPORTATIO'-J Fllli-:Rt\L AVL\TI<l:'< ·\D\llNhliU ll()t\ Cl\ II •\ Vi \li\J'; \I CI'IUTY



### Photograph provided by Tutein PRESTON, CBP Supervisory Officer, HENR 'y' 

### E. ROHLSEN AIRPORT (STX). 

### Saint Croix. US VI. Photograph shows two orange labels attached to t\.vo bottles \\hich contained Gas Oil. Class 3. UN 1202. PG-III.

--**--·--··-~--··-------··----------~~-------·-** ·---------·-· ------- 

### lnten iewed/Reviewed on

### A~·**t::-Pr~i"--1 _!_I~** **8.:_:2=c0"-'l~O'-----------** At 

### SJU-SECFU By 

### Special Agent Juan 

## Bl!LTED

. File No. 

### 20 IOS070003 7

FAA Form 1600-32-1 r9-86r FOR OFF!Cl!\L USE ONLY rPublic availahill!\ '''he dcrun>111v

# :~i(lc;j~I'*NM:INt 

# ··

# ~ . EXt'1lB11··· under 5 l.' 

### S C**.~32)**

# ~I~ '""!<,

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# 'n or IR:\'\SPClRIAI!ON FLDI R·\1 .\\'1.\ 11(>0. ,\/)\!!\/\lit\ //1 !\ ( l\'11 \\I·\ I!()\<,[ 1 !.**1~11** \'



### Photograph provided 

## by Tutcin PRESTON. 

## CBP Supervisory Officer, 

## HENRY E. ROHLSEN AIRPORT (STX), Saint Croix. USVL Close-up photograph showing two orange labels attached to two 

### bottles which contained Gas Oil. Class 3.**UN1~02.** 

### PG-11!.

lOP 5-D

lnterviewcd1 

### Reviewed on**.c..A~p'-!.r~il-'l'-'8~,-=2:..:o:O'-"l-"'O** 

### ________ ;\t 

### SJU-SECFU

H1 

### Special Agent Juan BULTED

---- . Fik No**~OlOS0700037 -··------------------~------------::::-:::-:::-::-:::::-::-:::-:--:-:--~:::---::~~**  FU 

### Form 1600-32-1 (9-86l 

### FOR OFFICIAL USE ONL'{ (Public availahility to be dclcnninc 

### under 5 U.S.C. 532)t .S UIP!\Rli\1LN I' OF TRANSPOR fAllON f f.IJIX\1 \\'1,.\1!()\: \D\!1NISfl{,\110\ '!\!I**\VI\IIt>.':~/(1** RITY



### Photograph provided 

## by lutein PRESTON, 

## CBP Supervisory Officer, 

## HENRY L ROJILSFN AIRPORT (STXJ, Saint Croix. USVI. Photograph shows the fiberboard box 

### \Vhich contained the shipment 

### of(ias OiL 

### Class J. 

### l''..;]202. PG-fll. Observe the 

### lack ofhazmat 

### markings and 

### communication labels



### fOP 5-l

--···---·--·



### Interviewed. Rnie11cd**onllQriU_~Ii,_201** 

### (}

______________ At 

### SJU-SECFl'



### B:- Special 

## Agent Juan 

## BULTIJ,).c_

__________.File 

### No. 

## 2010S0700m

. .:..7

_________________
FAA Form 1600-32-1 (<!-Xhi 

### FOR OFFICIAL USF ON! Y
t Public illailahillt' tn he Jctc-rnllnc· 

### under" L S C "3::'lt .::i. IXPART:-v1Ll\ I 01' TRANSPORTATIO"; llll/.f\.\1. ,\\ 1.\ IIU\ \D\11\IS II\\ JJ( 1\. (1\/1 \\1.\!/1>\'i/CII\1:,



### Photograph provided 

## by Tutein 

## PRESTON. CBP Supervisory Officer. 

## HENR'!" E. ROIILSFN AIRPORT (STX), Saint Croix. 

## USVL Photograph shows a plastic 

### bag which contained One bottle containing Gas Oil. Class 

## 3. UN 1202. 

## PC!- III.



## lOP 5-F

ln!crviewed/Reviewed on 

### April 18. 20 I0 At 

## SJU-SECFl'
By 

### _special Agent Juan BULTED

. File 

### N\l. 

### 2010S0700037

FAA Form 1600-32-1 r9-86J FOR OFFICIAL USE ONLY
! Puhlic ;n ailabilitv to he dctern111w under 5 US.C 532)

### t,:; DLPJ\RT\IENT OF TRANSPUWIAriON 11.1 lll{;\1 .'\ \ li\ II()'\ .'\D\IINIS IR\ II< l\; ('I\ II \\I\ lit**J~** Sl ('I :Ri I Y



### Photograph provided by 

### Tutcin PRESTON, CBP Supervisory Officer, HENRY E. ROfiLSL:\ 

### AIRPORT 

## (STX). Saint Croix. 

## US VI. Photograph shows the fiberboard box which contained the shipment of 

### Gas Oil. Class 3. UN 1202. 

### PG-III. Observe the 

### lack ofhazmat markings and 

### communication labels.

lnterviewediRevie\\Cd on**:...:Ao.t:p'-'-r~il_,l'-"8'-'-.-"2'-"0'-"l.:c:O** 

### ________ At 

## S.IU-SECFU
By 

### Special Agent Juan BLLTED

________.File No. 

### 20JOS0700037

FAA Form 1600-32-1 ('l-81>1 FOR OFFICI.AL USE 0\!LY

<Put>l1c :1\ :ulahdlll to he Jt'lcnnit:,· 

### under) L S C 5321t ·.S. DLJli\IU:\lFNl OF TR/\l\SPORT·\ liON lli>IJUl .\\1\TI()\ \D:..ll'-ISIIC\ll(h
t !\'II \\'!\Ill•\ \I(! 1(11\



### Photograph provided by Tutein PRESTON. CRP Supervisory Officer. HENRY E. ROHLSEN AIRPORT (STX), Saint Croix, USVI Photograph shows the fiberboard box which contained the 

### shipment of Gas Oil. Class 3, UN 1202. 

### PG-III. Observe the lack 

### of haZinat 

### markings and communication labels.

Inten iewed/Reviewed on 

### '--'A""p:.:.r.:.:i l__,l'-"8'-'-'--=2::..::0:....ol-"'O

_______ _ 

## B: Special i\gcnt Juan BULTED

FAA Form 1600-32-1 t9-R6i At 

### SJU-SEC:FL

. I 

### lie No. 

### 201 

### OS0700037

FOR OFFICIAL USE ONLY (Public availablitt) W be <kterminl' under 5 USC 532)

# I

FAA NATIONAL OPERATIONS AND TRAINING MANUAL FOR THE NON-ACCEPTANCE AND NON-TRANSPORT OF DANGEI{OUS GOODS IN AIR TRANSPORTATION

Coastal 

### Air Transport 

### (Air Carrier Name)
AT 

### 761-109 

### (Certificate Number)
227 Rosegate, Box 3985 

### (Physical Address) Christiansted, 

### (City) (340)773-6862 

### (Telephone)

# ~hLL>J1 (Signature Block) Corporate Officer St Croix, Virgin Islands 00822 

### (State) (Zip Code) (340)773-6862 

### (Fax)

# ~1Jg~-4--- (Signature Block) Responsible Haz:ndous Materials Officer



## Statement ofIntent: Air Carrier 

## \VILL NOT ACCEPT Dangerous Goods (DG) for Air Transport 

# Will Transport Commercial DG? 

# 0 N

# 0
Will Transport Own DG Company Material (COMAT)?

# ~~0?#~ Recommend Acceptance/ Approval t.'\AS Dangerous Goods Coordinator

# YJ~L v:1t) 1 / 

# 919'
FAA APPROVAL

# ~**}%~** SIGNATURE;:==!.**~Gc, c!~ic:A-** **3~/** 

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# EXHIBIT-"~-

# I

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# • FIGURE 8.1.8 

## Shipper's Declaration Specimen Designed for Manual Completion**~**

# ~**~ ~** 

# ~**~ ~** 

# ~**~ ~** 

# ~**~ ~** **~**

# ~**~ ~** **~ ~** 

# ~

# ~**~**

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# • SHIPPER'S DECLARATION FOR DANGEROUS GOODS Shipper

Consignee

Two completed and signed copies ofthis Declaration must be handed to the operator. Air Waybill No.
Page of Pages Shipper's Reference Number (optiOnal)



# I WARNING For optional use for Company fogo name and address

TRANSPORT DETAILS This Shipment is within the Airport of Departure: limitations prescribed for: (delete non-applicable)

AND CARGO AIRCRAFT 

# I

PASSENGER 

# I CARGO 

# I Failure to comply in all respects with the applicable Dangerous Goods Regulations may be in breach of the applicable law, subject to legal penalties. This Declaration must not, in any circumstances. be completed and/or signed by a consolidator. a forwarder or an lATA cargo agent AIRCRAFT ONLY Shipment type: (delete non-applicable) Airport of Destination: 

### I NON-RADIOACTIVE 

### I RADIOACTIVE 

### I
NATURE AND QUANTITY OF DANGEROUS GOODS



### -------------------**------------------------------------~--** Dangerous Goods Identification

---- --------------------------------------------
Proper Shipping Name ' '
. 'Class·

or : Divi-:

: S!On

. UN or 10 No. Pack-' Subs1- · ing cjiary :Group; Risk Quantity and type of pack :ng Pack1ng lnst Authorization**~-------------------------------------------** Additional Handling Information

NamefTitle of Signatory

Place and Date 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 labelled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. Signature

# ~GOVERNMIN~~-------------~4~------~-~e_w_m,_ng-abo-~;------------~ i 'HIBIT 

# exJ-\IBJT

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# 1

.... ..,..,,. I : ··<·< I ,,.;e, ., ''''··**H:;·,,;~**

## § 172.312

t}Ltl i'l•IJJ'<It·lll:-' ((l l !H· t'l'ljllit'I'Jll(·tJl:-' (i].

.\pj)i'lldi.\ B IJi I ili> !J<il'l '('' E:l< l! T\'jlf' 

# nrc· I. T\'jlt' H· \]I ()j l'i>:>i 

### !<- JlLt t et·i .1 

### I )l:w 1\:1:.::' .!1 ':-;t: lli 

### ·d JoJ •<\!Jilt·: >llij)lllt>ll( ti1U:-'l ,I]>IJ iH· llL\I'l\1•!/**-~-~--<\.** Ill ,·•Jt1jUJ!l·(tOll \\'!til til<· >j)i'<'li'il :tllliL !1Ltl kiw..:. •11 

### nt Itt·!· p;t<·k.t"'' ··r·t·- tii'il:tt< l<it'llti!i(';\ll()Jl**(~{'( ~~1'7:)**  

### 171.**)-;-:;j/~.** IJJ.J ]/:) 

### J'7:l <•l flit> "lliH·)Jiipl•'J .I 'II••• k• I \·• 1:;-;l'\**'1~1 <i~IU**  •ll\1 _;:;(I• <i:1 1·'1-: :)fih(; -l.tll ..'li.**~(l()jl ~**  

### l72.:n 2 Liquid hazar·dous mater·iais in non-bulk packagings.

. a 1 EXt'I'IJl**o~:.:** PJ'Il\'Jd!•d lll tllJ:-; ,.;('i'l io11. •':11·ll !Hill ilttlk ('(J!lt!Jitl:tti()ll p;H·l\:ag!' lt;t\'iJI:_: !tll11'1 !Jilt'k,\"!11"> ('11111.\Jllill." 

### liquid !J.tzanluu:-; m.ti<'l'1:th. :-;ingf<> p:t<·l\;t"IW: litlt'cl Will1 \'t'll[:-'. 01 Oj)('ll ,·t·.\·o"r't1i< n:t.'(•pl:il li· illlt'!ldi'd !'O!' 

### the t J'illl:>IJ(I!'( 

## or l'i'lt'i"!'l':ttt>d liljlll'fil'd**";~;.;(•;-;** lllll:>t 11(':

'1 1**P:td~t·d** wit 11 1 IO:->lll'i':> upward. and**1~1** LegiiJ!.\· nt:trk••d \Vitll**p;tl·k::t~l'** orit·llt:lliotJ rn:trb:itJg:-; tlLtt :t.n· :-;imilar to tl11' illu:>t!':ltion 

### :-elwwn in thi:-; 

### para- "l':tplt. till two oppo:-;}(1' \'('!'( knl :-:idl':> 

# or tll·· 

### p:td\a"l' witl1 llH· :tnow:-; pointin" i11 t 

### lJ1· 1 r>!Tt't'l upJi"llt tlin•t·t ion TlH· :tJTow:-: tnu:-;t IJI' l'i t IJ.-J' hl:tt·k ot· n•d 

### on w!Jik or IJtlwt· :-;uit:ill!t·**t'Clllt1:t:>Lin~** l1:t< · k"I'tJU!ld 

### :tnd 1 1Jtn nwn:-:ur:t t 

### e wi 

### Lll tllf• :-:iz1• ol till· p:Jd.;;t"\'. D1Jpit:t in" :1 l'(•t·(;lll"Ui:t1' iJo!'tlt•J' ;\!'OUJ1d llli' :!!TOW:-; 

### i '" I) pt 

### i (Ill ;\I.

Package orientation 11,1 :\t'l'O\\':-; 

### Cnr purpo:>''" 11tller tll;tn ltll! tt·:t ti**11~** nt OIH'l' D:tcl·::-ln' orit"lllat ion 

### 49 CFR Ch. I (10-1-09 Edition)

ma.\· not ill' di:-;pLt.\';•d on :1 pal'ka.g·v <'illlL!illtll.'-! <1 ]iqUirllLtZ;tl'dOliC: /1l:ll·!'l'i:tl

.

It_., 

### The l'r·'qUli'l'lll<'lll:> (lj Jl:tJ';tgT;tph 1,1; ()j t 

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### n
I 

### 1 i .\ !)()Jl-lilJ] 

### k j)<t< 'k;L"(· Wi! ]! 

### i llllt'! p;tl' k:t gin.""' wlli1 

### ·II :\l't' 

### '·.\'! i ndt'l>
121 EXl'!'!Jl 

### \\·llvn IJf'f't•J't•<l 111 !tit t'lHit-d (OJ' ll':ll1:>j)OJ't;ttil1ll IJ\' :til',l'l':llt. j)<li'k·
.we:-: ,·(I!!Ltillitlc: I'Lil1llll:ihk liquid:-; ill intl!'l' p:H·k:tc..:in"> 111 

### 1 I. <11 

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### en 1c·1 111 t!1i:> :-;ulwhapt.c·J 1:)1 \\'11!'!1 Ol'/t'l'l'li ill lll(<•!)ll(·d 

### Jot ll'<lll:>!JOl'l<ltiO!l i1,\· .tit·t·I;Iit. j!i\('k;t"l':> c·ontaining rl;lmtn:llili' 

### liquid:-; ill Jttnc·r P<ll'l\ag·ing:-; 

### ot 120 

### mL 1 

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# , Pipeline and Hazardous Materials Safety Admin

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## FlAMMABLE GAS 

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## FLAMMABLE LIOUID 

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