Note: Only one hazardous material may be submitted per form.

Please ensure all of the following are true before submitting this form:

• the purchase is being made with a PCard
• the hazardous materials are infrequently needed
• the hazardous materials are available only from specialty vendors
• there are no established Blanket Purchase Orders in place with vendors who can supply the majority of a College’s or Department’s hazardous materials need

Upon EH&S confirmation, the requestor(s) will receive a confirmation number via email to be kept on hand for future purchases of this material. This confirmation number does not expire unless any of the information on this form requires updating.