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City/State/Zip within Days <br /> If as direct result of hazardous materials release during transportation <br /> (including loading,unloading and temporary storage), <br /> ANY of the following questions are answered with a YES,the DOT F 5800.1 form must be submitted per 29 CFR <br /> 171.16 <br /> A. Was notification made to the NRC? ❑Yes ®No <br /> B. Is this an unintentional release during transportation (including loading, unloading and ❑Yes ®No <br /> temporary storage)? <br /> C. Is the material a hazardous waste? ❑Yes ®No <br /> D. Is this an undeclared shipment of hazardous material? ❑Yes ®No <br /> E. Is this a specification cargo tank 1000 gallons or greater that received structural ❑Yes ®No <br /> damage to the lading retention system (tank shell, piping,valves,etc.) and did not <br /> release? <br /> The DOT F 5800.1 form is NOT required if ALL of the following apply: <br /> A. The shipment is NOT being transported by air. ❑ Applies <br /> B. The material is an ORM-D or a PGIII material in Class or Division 3,4,5, 6.1,8 or 9. ❑ Applies <br /> C. Each package has a capacity of less than 5.2 gallons for liquids or less than 66 lbs.for ❑ Applies <br /> solids. <br /> D. The total aggregate release is less than 5.2 gallons for liquids or less than 66 lbs.for ❑ Applies <br /> solids. <br /> 5800.1 Form(if required)to be completed by: <br /> 6 <br /> Page 9 of 14 <br />