MULTIMODAL DANGEROUS GOODS FORM This farm may bo vsed as a dangerous goods daciaraton as it maets the requirements of SOLAS 74, chapter Vil, regulaton 5: 5, Freight forwarder reference 6 Consignes Aare [TO ORDER fr carrier: [s. SHIPPER'S DECLARATION I hereby deciare tha the contents ofthis consignment are fully and accurately |seseribed bellow by the Proper shipping Name, and are classified, packaged, }marked and labelled pizcarded and are inal respects in proper condition for fans 10 he spplicabl international and nation ations. 8. This shipment is within the mtaions prescribed for; _|9. 24 Hour Emergency Telephone Numb Pear enn an date _ a 2 12, Poriplace of discharge 13. Destination teres |CONSTANZA LCONSTANZA 14. Shipping marks Number and kind of packages; description of goods Gross mass Net mass(ig) Cube {UN3082,UN3077,UN3077 07-5KGS 1000KGS —_2CBM 28KGS 2SKGS_02CBM » fe sks | 200KG3_ cam us no: ENVIRONMENTALLY HAZARDOUS SUBSTANCE,LIQUID.N.OS. "ERONUL BUTOXIADE ENVIRONMENTALLY HAZARDOUS SUBSTANCE SOLID.N.OS, DIFLUBENZURON ENVIRONMENTALLY HAZARDOUS SUBSTANCE SOLIDN.OS, TETRAMETHRIN cope Sipping Nametoch Name): come 19919 ackage Gooup: TH IT, Number of Package: ‘SDRUMS(221,5KGS200KGS,1DRUMS24KGS2SKGS)SDRUMSBTKGSASKGS) ar: ‘YES,YES,YES EMS: FASFIEAS ERASE Flash Point: NO.NO.NO 13. Container Wenticaton NOT 16 Seal oerberG) 7. Conamnarvenienze ® 5p is Fare mass Tis Tot gost mass vehicle reistraton No. [os Gretesing ar) . 37> ew t20GP omnes |ssassk@s. 3.2CBM| |CONTAINER/VENICLE PACKING CERTIFICATE Thereby desis ht the goods described above ave been packedtosded inte conuinervebicl idectiied above i sscorducs wth the spice provisions ++ UST BE COMPLETED AND SIGNED FOR ALL CONTAINER! Pt. RECEIVING ORGANIZATION RECEP [Received the number of packages/container/uailersin apparent sve xe and concen, us stad hereon: RECEIVING ORGANIZATION REMARKS: tawiers name Vehicte eg ao. Is Signature and date pelutant and observe eR fie IDG Code 05.425 ements under applicable national and intematonel govermmental ezulations. FOP Forte purpose! he MDG Cals 542. DRIVERS SIGNATURE ‘Name, hazard class, UN No. packaging group, (where wglofeay Mane