Hazmat Registration

Hazmat Information – MCS-150B

Hazmat registration on Form MCS-150B is optional unless your company transports hazardous materials that require an FMCSA Hazardous Materials Safety Permit (HMSP). If you carry qualifying hazmat, you must complete the hazmat section on the MCS-150B. If you do not transport hazmat, you may leave this section blank.

Step 1 of 8

12%

Reason For Filing (select only one):

New Application

Biennial Update or Changes

Out of Business Notification

Reapplication (after revocation of new entrant)

Reactivate

LEGAL BUSINESS NAME:

DOING BUSINESS AS NAME

(if different from Legal Business Name):

PRINCIPAL PLACE OF BUSINESS (see 49 CFR 390.5T):

STREET ADDRESS/ROUTE NUMBER

CITY

STATE/PROVINCE

ZIP CODE

COLONIA (Mexico only)

MAILING ADDRESS:

Same as Principal Address

Mailing address below:

STREET ADDRESS/ROUTE NUMBER

CITY

STATE/PROVINCE

ZIP CODE

COLONIA (Mexico only)

CONTACT NUMBERS:

PRINCIPAL BUSINESS PHONE NUMBER

PRINCIPAL CONTACT CELL PHONE NUMBER

PRINCIPAL BUSINESS FAX NUMBER

IDENTIFICATION NUMBERS:

USDOT NUMBER

MC or MX NUMBER

DUN & BRADSTREET NUMBER

IRS/TAX ID NUMBER

(see instructions before completing this section)

E-MAIL ADDRESS:

CARRIER MILEAGE

(to nearest 10,000 miles for the previous 12 months):

COMPANY OPERATIONS (check all that apply):

Interstate Carrier

Intrastate Hazmat Carrier

Intrastate Non-Hazmat Carrier

Interstate Hazmat Shipper

Intrastate Hazmat Shipper

OPERATION CLASSIFICATIONS (check all that apply):

Authorized For-Hire

Exempt For-Hire

Private Property

Private Motor Carrier of Passengers (Business)

Private Motor Carrier of Passengers (Non-Business)

Migrant

U.S. Mail

Federal Government

State Government

Local Government

Indian Tribe

CARGO CLASSIFICATIONS (check all that apply):

General Freight

Household Goods

Metal: Sheets, Coils, Rolls

Motor Vehicles

Drive Away/Towaway

Logs, Poles, Beams, Lumber

Building Materials

Mobile Homes

Machinery, Large Objects

Fresh Produce

Liquids/Gases

Intermodal Container

Passengers

Oil Field Equipment

Livestock

Grain, Feed, Hay

Coal/Coke

Meat

Garbage, Refuse, Trash

U.S. Mail

Chemicals

Commodities Dry Bulk

Refrigerated Food

Beverages

Paper Product

Utility

Farm Supplies

Construction

Water Well

Other listed below:

Other

HAZARDOUS MATERIALS (Carrier or Shipper)

(check all that apply):

(C=Carrier; S=Shipper; B=Bulk, in cargo tanks; NB=Non-Bulk, in packages)

A. DIV 1.1

B. DIV 1.2

C. DIV 1.3

D. DIV 1.4

E. DIV 1.5

F. DIV 1.6

G. DIV 2.1 (Flam. Gas)

H. DIV 2.1 LPG

I. DIV 2.1 (Methane)

J. DIV 2.2

K. DIV 2.3A

L. DIV 2.3B

M. DIV 2.3C

N. DIV 2.3D

O. CLASS 3

P. COMB LIQ

Q. DIV 4.1

R. DIV 4.2

S. DIV 4.3

T. DIV 5.1

U. DIV 5.2

V. DIV 6.1A

W. DIV 6.1B

X. DIV 6.1 LIQUID

Y. DIV 6.1 SOLID

Z. DIV 6.2 (Infect. Substance)

AA. DIV 6.2 (Select Agents and Toxins)

BB. CLASS 7

CC. HRCQ

DD. CLASS 8

EE. CLASS 8A

FF. CLASS 8B

GG. CLASS 9

HH. ELEVATED TEMP. MAT.

II. INFECTIOUS WASTE

JJ. MARINE POLLUTANTS

KK. HAZARDOUS SUB (RQ)

LL. HAZARDOUS WASTE

MM. LTD. QTY.

Vehicles

Number Of Vehicles That Will Be Operated In The US:

Truck and Trailers

Passenger Vehicles

Truck and Trailers:

Straight Trucks

Truck Tractors

Trailers

Hazmat Cargo Tank Trucks

Hazmat Cargo Tank Trailers

Owned Straight Trucks

Term Leased Straight Trucks

Trip Leased Straight Trucks

Owned Truck Tractors

Term Leased Truck Tractors

Trip Leased Truck Tractors

Owned Trailers

Term Leased Trailers

Trip Leased Trailers

Owned Hazmat Cargo Tank Trucks

Term Leased Hazmat Cargo Tank Trucks

Trip Leased Hazmat Cargo Tank Trucks

Owned Hazmat Cargo Tank Trailers

Term Leased Hazmat Cargo Tank Trailers

Trip Leased Hazmat Cargo Tank Trailers

Passenger Vehicles

Motor-Coach

School Bus (8 or less Passengers)

School Bus (9-15 Passengers)

School Bus (16+ Passengers)

Bus (16+)

Van (8 or less Passengers)

Van (9-15 Passengers)

Limousine (8 or less Passengers)

Limousine (9-15 Passengers)

Owned Motor-Coach

Term Leased Motor-Coach

Trip Leased Motor-Coach

Owned School Bus <8

Term Leased School Bus <8

Trip Leased School Bus <8

Owned School Bus 9-15

Term Leased School Bus 9-15

Trip Leased School Bus 9-15

Owned School Bus 16+

Term Leased School Bus 16+

Trip Leased School Bus 16+

Owned Bus 16+

Term Leased Bus 16+

Trip Leased Bus 16+

Owned Van <8

Term Leased Van <8

Trip Leased Van <8

Owned Van 9-15

Term Leased Van 9-15

Trip Leased Van 9-15

Owned Limousine <8

Term Leased Limousine <8

Trip Leased Limousine <8

Owned Limousine 9-15

Term Leased Limousine 9-15

Trip Leased Limousine 9-15

NUMBER OF NON-COMMERCIAL MOTOR VEHICLES (NON-CMV) THAT WILL BE OPERATED IN THE U.S.:

Non- CMV

DRIVER INFORMATION

Within 100-Mile Radius

Beyond 100-Mile Radius

INTRASTATE Drivers (Within 100-Mile Radius)

INTERSTATE Drivers (Within 100-Mile Radius)

INTRASTATE Drivers (Beyond 100-Mile Radius)

INTERSTATE Drivers (Beyond 100-Mile Radius)

IS YOUR USDOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FMCSA?

Yes

If yes, enter your USDOT Number:

PASSENGER CARRIER COMPLIANCE CERTIFICATION:

ALL MOTOR PASSENGER CARRIER APPLICANTS must certify as follows:

Applicant is fit, willing, and able to provide the proposed operations and to comply with all pertinent statutory and regulatory requirements, including the U.S. Department of Transportation’s Americans with Disabilities Act regulations for over-the-road bus companies located at 49 CFR Part 37, Subpart H, if applicable.

Yes

Private entities that are primarily in the business of transporting people, whose operations affect commerce, and that transport passengers in an over-the-road bus (defined as a bus characterized by an elevated passenger deck over a baggage compartment) are subject to the U.S. Department of Transportation’s Americans with Disabilities Act regulations located at 49 CFR Part 37, Subpart H. For a general overview of these regulations, go to the Federal Motor Carrier Safety Administration’s Web site at https://www.fmcsa.dot.gov/regulations/americans-disabilities-act-reporting-and-other-requirements-over-road-bus-companies

30-WHICH OF THE FOLLOWING HAZARDOUS MATERIALS DOES YOUR COMPANY TRANSPORT? (check all that apply):

Highway Route Controlled Quantities (HRCQ) of radioactive materials.

More than 25 kg (55 pounds) of a Division 1.1, 1.2, or 1.3 material or a quantity of Division 1.5 material that requires placarding.

For materials that meet the definition of “material poisonous by inhalation” (TIH) as defined in 49 CFR 171.8: More than 1 liter (1.08 quarts) per package of a material meeting the definition of a Hazard Zone A TIH material; a material meeting the definition of a Hazard Zone B TIH material in a bulk package (capacity greater than 450 liters [119 gallons]); or a material meeting the definition of a Hazard Zone C or D TIH material in a bulk packaging that has a capacity greater than 13,248 liters (3,500 gallons).

Shipments of compressed or refrigerated liquid methane or liquefied natural gas with a methane content of at least 85% in a bulk packaging that has a capacity greater than 13,248 liters (3,500 gallons).

IF YOU CHECKED QUESTION 30, ARE YOU APPLYING FOR OR RENEWING A HM SAFETY PERMIT? (please check one):

Initial

Renewal

IF YOUR COMPANY DOES NOT HAVE A USDOT NUMBER, HOW MANY ACCIDENTS AS DEFINED IN 49 CFR 390.5 HAS YOUR COMPANY HAD IN THE PAST 365 DAYS?:

DOES YOUR COMPANY CERTIFY THAT THEY HAVE A SATISFACTORY SECURITY PROGRAM IN PLACE AS REQUIRED IN 49 CFR PART 385, SUBPART E? (please check one):

Yes

IS YOUR COMPANY REQUIRED BY ANY STATE(S) TO HAVE A PERMIT FOR ANY OF THE HAZARDOUS MATERIALS LISTED IN QUESTION 30? (please check one):

Yes

IS YOUR COMPANY REQUIRED BY ANY STATE(S) TO HAVE A PERMIT FOR ANY OF THE HAZARDOUS MATERIALS LISTED IN QUESTION 30? (please check one):

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

U.S. Virgin Islands

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Armed Forces Americas

Armed Forces Europe

Armed Forces Pacific

NOTE: All motor carriers must comply with all pertinent Federal, State, local and tribal statutory and regulatory requirements when operating within the United States. Such requirements include, but are not limited to, all applicable statutory and regulatory requirements administered by the U.S. Department of Labor, or by a State agency operating a plan pursuant to Section 18 of the Occupational Safety and Health Act of 1970 (“OSHA State plan agency”). Such requirements also include all applicable statutory and regulatory environmental standards and requirements administered by the U.S. Environmental Protection Agency or a State, local or tribal environmental protection agency. Compliance with these statutory and regulatory requirements may require motor carriers and/or individual operators to produce documents for review and inspection for the purpose of determining compliance with such statutes and regulations.

PLEASE ENTER NAME(S) OF SOLE PROPRIETOR, PARTNERS, OR OFFICERS, AND TITLES

(e.g., president, treasurer, general partner, limited partner)

(Please type or print names 1)

(Please type or print titles 1)

(Please type or print names 2)

(Please type or print titles 2)

Consent

I certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal (please type or print name) (please type or print names) (please type or print titles) Hazardous Materials Regulations. Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, true, correct, and complete.

Name:

Signature:

Title:

(please type or print)

Date

MM slash DD slash YYYY