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SHIPMENT INFORMATION D. O.T. Shipping Name Hazard Class Non-Regulated Type of Containers 55 gal. drums / cubic yard boxes / supersacks / Other Number of Pieces to be loaded Special Instructions. Please send this completed form to Barbra Tychinski LTL Coordinator E-mail btychinski hazmatinc.com Direct phone 716-748-8293 Direct fax 716-748-8386 Name of person placing request E-mail and phone PICKUP LOCATION Name of Facility Address Street City State Zip Contact Person at Pickup Location Phone...
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