PCard Hazardous Material Procurement Requests

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.

 

Person who has ultimate responsibility for the overall handling, management, and training pertaining to hazardous materials in a laboratory, shop, or otherwise designated space.

 
 
 
 
 

Please provide a brief explanation as to why this exemption is needed.

 
 

Chemical Identification

Reminder: please only submit this form for one product at a time.

 
 

Please reference Section 3 of the associated Safety Data Sheet to find the CAS number(s) assigned to the desired material.


Please separate all CAS numbers with commas.

 
 

Please provide the name and URL for the chemical vendor.

 
 
 

Please identify the building that the hazardous material will be stored in.

 

Please identify room that hazardous material will be stored in.

 
 

Please identify where within the room the hazardous material will be stored.

 
 
 

Hazard Identification

 

Do Sections 2, 3, 7, 8, 10, 11, or 15 of the SDS for the material listed above identify the material as being hazardous? You may also reference the Cal-OSHA Hazardous Substance List.

 
 

Please attach safety data sheets for the items that are identified on this request form.

Drop your files here