Requestor Name:

Department:

Requested Date of Decontamination:

Email Address:

Contact Phone:

Room/Lab#:

Building (McD, IBT, DTL, etc.):

Disposition:
Moving
Service/Repair
Surplus (Warehouse)

Hazard (to select more than one item, Windows users hold down CONTROL key and click,
Mac users hold down Command/apple key and click):
Biological Chemical Radiological

Cabinet Usage:
Biosafety Level-2 Agents
ANY Human Cell Lines
Human Blood
Human Tissue
Infected Animal Cell Lines, Tissues
Primate blood, tissue
Viruses (examples are Adenovirus, Herpes Virus, Vaccinia Viruses)
Bacterial Agents (examples are Chlamydia, S. Pneumoniae)
Fungal Agents
Parasitic Agents
Biosafety Level-1 Agents
Animal Cell Lines (non-infected)
Non-Infected Animal Tissue
If your cabinet usage is not listed above, please contact Rebecca Bloodworth, Erica Castillo or Jaime Cerecero at 567-2955.

Principal Investigator: ----- Approved:

Additional Comments:

List of Cabinets to be cleared (up to 10 pieces):