SHIPPER'S DECLARATION FOR DANGEROUS GOODS (Provide at least two copies to the airline.

)
Shipper Air Waybill no. A424715
P.T. Baker Atlas Indonesia
South Quarter Level 18 & 19 Tower B Page 1 of Pages 6 1
Jl. R.A. Kartini Kav. 8, Cilandak Barat
Jakarta 12430, Indonesia Shipper's Reference Number
T +62 21 5730500 | F +62 21 80649815 (optional)

Consignee
Baker Hughes Operation Mexico
Antonio Dovali Jaime 70
Alvaro Obregon
Ciudad De Mexico CMX 01210 MX
Two completed and signed copies of this Declaration must WARNING
be handed to the operator

TRANSPORT DETAILS Failure to comply in all respects with the applicable Dangerous
This shipment is within the Airport of Departure: Goods Regulations may be in breach of the applicable law, subject
limitations prescribed for:
(delete non applicable)
to legal penalties.
Soekarno Hatta
xxxxxxxxxxx
PASSENGER AND CARGO
CARGO AIRCRAFT Airport,
xxxxxxxxxxx
CARGO AIRCRAFT AIRCRAFT ONLY
INDONESIA
Shipment type: (delete non-applicable)

Airport of Destination: MEXICO CITY xxxxxxxxxxxxxxxxx

NON-RADIOACTIVE RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification
UN or Class or Packing Quantity and Type of packing Packing Authorization
ID No. Proper Shipping Name Division Group Inst.
(Subsidiary Risk)

UN 2911 RADIOACTIVE MATERIAL, EXCEPTED 7 Cs-137

PACKAGE-INSTRUMENTS 1 Plywood box x 29,6 kBq

Additional Handling Information

Emergency contack : Mario Bagiyo Saputra (RPS) +628115388399 and Ade Darnis (PIC)+628115993340

Name:
I hereby declare that the contents of this consignment are fully and accurately described
above by the proper shipping, name and are classified, packaged, marked and Mario Bagiyo Saputra
labelled/placarded, and are in all respects in proper condition for transport according to the
Date :
applicable international and national governmental regulations. I declare that all of the
applicable air transport requriements have been met. 5 July 2023
Signature
(see warning above)