BULK STORAGE/UNLOADING FORM
FAX TO 410-527-9229
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1. Customer Name
2. Name & Address of
    Storage Location 
    City            State/Zip       
3. Product
4. Number of Tanks           Capacity      
5. Is Product Identity Marked on Each Tank?
YES NO
    Is Line Hook-up Identified?
YES NO
6. Is There a Fill Gauge on the Tank?
YES NO
    Is Fill Gauge in View of the Driver While Unloading?
YES NO
7. Average Quantity of Each Shipment:
8. Size and Length of Hose Required with Rear Unloading Truck:
9. Type and Size of Fittings Required:
10. Normal Unloading Hours:
     Can Unloading Hours be Extended:
YES NO
      To What Hours:
11. Is Compressor Required?
YES NO
12. Is Pump Required?
YES NO
13. Pump/Compressor Specification:
14. Does Customer Supply Pump and Compressed Air?
YES NO

SAFETY UNLOADING
Are Safety Showers Available at the Unloading Point?
YES NO
If no, How Far is Nearest Water Available?
Does Customer have Personnel assigned to the Unloading area to assist the Driver?
YES NO

SAFETY EQUIPMENT REQUIRED BY TRUCK DRIVER
Type of protective gear required:
STEEL TIP SHOES
YES NO
HARD HAT
YES NO
RUBBER JACKET/ PANTS
YES NO
GLOVES
YES NO
FACE SHIELD/EYE WEAR
YES NO

If any other type of safety equipment is required please list below:
1.
2.
3.
4.
15. Is a Certificate of Analysis required with each shipment?
YES NO

16. OTHER SPECIAL INSTUCTIONS 		 
1.
2.
3.
4.

LOCATION INFORMATION
Main Telephone#
Fax#
Night#
   
Receiving Manager
Ext#
Q/A Manager
Ext#
Production Manager
Ext#
Safety Manager
Ext#
Emergency Contact
Ext#

ALLEGIANCE CHEMICALS LLC CONTACTS

David T Burdette
Susan M Burdette
David's car phone
David's pager		 Tel#
Tel#
Tel#
No.#

410-252-3300
410-252-3300
410-382-7282
800-809-4382

We can be reached 24hrs a day / 7 days a week.
EMERGENCY: 410-252-3300 once recording starts press 5