Request for Hazardous Commodity Flow Information

Organization Requesting Information:
Contact Person (Name & Rank/Title):
Phone Number:
Mailing Address:
ZIP Code:
Geographical Description of Area for study (e.g. City/County):
Preferred method to receive report: Email     U.S. Mail (Mark one)
By submitting this form, I acknowledge and agree to the terms set forth by Union Pacific Railroad for use and dissemination of the information contained within the Union Pacific Railroad Hazardous Materials Commodity Flow Information. Union Pacific Railroad considers this information to be restricted information of a security sensitive nature. I affirm and agree that the information provided by Union Pacific Railroad in this report will be used solely for and by bona fide emergency planning and response organizations for the expressed purpose of emergency and contingency planning. This information will not be distributed publicly in whole or in part without the expressed written permission of Union Pacific Railroad.