Laboratory Chemical Cleanout Request Form

Please complete this form to request the assessment and removal of excessive chemicals, abandoned chemicals, and/or high hazard materials that require special handling (e.g. explosives, water sensitive, toxic, or unstable items).

Name of Requestor Name of Requestor First Last
Email
Phone Phone - ### - ### ####
Lab Location (Campus, Bldg, and Room Number)
Select your relationship to the lab space(s):
Can any of the chemicals be used by other laboratories? IMPORTANT! Shared chemicals must meet the following requirements:
1. Label is legible and intact
2. Chemical is not expired
3. Container is in good condition

Can any of the chemicals be used by other laboratories? IMPORTANT! Shared chemicals must meet the following requirements:
1. Label is legible and intact
2. Chemical is not expired
3. Container is in good condition Yes No
Please attach a list of the chemicals you plan to share. Make sure to remove these items from your lab's inventory in the EH&S Chemical Inventory System.

Attach Files
Please attach a list of the chemicals to be removed from the space. Include the volume and quantity for each item. IMPORTANT! All items should have a legible label with container and lid intact. Any compromised containers or containers missing labels should be indicated on the list.

Attach Files
Optional: You may include a photo of items to be removed here:

Laboratory Chemical Cleanout Request Form

Laboratory Chemical Cleanout Request Form

Optional: You may include a photo of items to be removed here: