SURPLUS CHEMICAL REQUEST

Name___________________________________Telephone__________________________

Building/Room_____________________________________________________________

Item Number                  			 Description       			       Quantity	

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Please check the list at: http://home.ncifcrf.gov/ehs/wm/surplus/list_chem.asp. Your request may already be given to someone else.  “First come, first served”

Return this sheet by inter-office mail to Waste Management Building 1071, or fax to x7442 ATTN: Surplus Chemicals.

Revised 11/15/04