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PART III - PACKAGING INFORMATION 24. Check Packaging Type (check only one - if more than one, list type of packaging, copy Part III, and complete for each type: ❑ Non -bulk ❑ IBC ❑ Cargo tank Motor Vehicle (CTMV) 0 Tank Car ❑ Cylinder ❑ RAM ❑ Portable Tank ❑ Other N/A 25. See instructions and enter the appropriate failure codes found at the end of the instructions. Be sure to enter the codes from the list that corresponds to the particular packaging type checked above. Enter the number of codes as appropriate to describe the incident. Enter the most important failure point in line 1. If there are more than two failure points, provide in this format in part VI. 1. What Failed: 133 2. What Failed: How Failed: 308 How Failed: Causes of Failure: 526 Causes of Failure: 26a. Provide the packaging identification markings, if available. Identification Markings: 111A100W1 (Examples: 1A1/Y1.4/150/92/USA/RB/93/RL, UN31H1/Y0493/USA/M9339/10800/1200, DOT- 105A- 10OW (RAIL), DOT 406 (HIGHWAY), DOT 51, DOT 3-A) 26b. For Non -bulk, IBC, or non -specification packaging, if identification markings are incomplete or unavailable, see instructions and complete the following: Single Package or Outer Packaging: Packaging Type: N/A Material of Construction: N/A Head Type (Drums only): ❑ Removable 27. Describe the package capacity and the quantity: Single Package or Inner Packaging (if any): Packaging Type: N/A Material of Construction: N/A ❑ Non -Removable Single Package or Outer Packaging: Single Package or Inner Packaging (if any): Package Capacity: 205600 Liquid - Pound Package Capacity: N/A Amount in Package: 203683 Liquid - Pound Amount in Package: N/A Number in Shipment: 1 Number in Shipment: Number Failed: 1 Number Failed: 28. Provide packaging construction and test information, as appropriate: Manufacturer: UTLZBN Manufacture Date: N/A Serial Number: UTLX200074 Last Test Date: N/A Material of Construction: ASTM A515, Gr. 70 (if Tank Car, CTMV, Portable Tank, or Cylinder) Design Pressure: N/A (if Tank Car, CTMV, Portable Tank) Shell Thickness: 0.4370 (if Tank Car, CTMV, Portable Tank) Head Thickness: 0.468 (if Tank Car, CTMV) Service Pressure: N/ (if Cylinder) If valve or device failed: Type: N/A Manufacturer: N/A Model: N/A (if present and legible) (if present and legible) 29. If the packaging is for Radioactive Materials, complete the following: Packaging Category: Packaging Certification: Nuclide(s) Present: N/A Activity: N/A ❑ Type A ❑ Self Certified ❑ Type B ❑ Type C ❑ U.S. Certification Transport Index: ❑ Excepted ❑ Industrial Certification Number N/A N/A Critical Safety Index: N/A ' Form DOT F 5800.1 (01-2004) Page 2 Reproduction of this form is permitted