Please read instructions
CSDF Only Please
below for details and our
Date Recvd.
Terms and Conditions.

Plan Ahead!
CSDF Chemical Requisition Form
RQ#
First Name:
Last Name:
Requestor's Phone:
Advisor or Supervisor Name:
Requestor's Email:
Department:
Building:
Lab / Room No.:
Banner Index No.:
or FOAP
-
- 5420 -
Number of
Size of
Chemical name, purity, grade (ACS, HPLC, etc.), vendor name, catalog or
MSDS?
CSDF Only Please
Containers Containers product number, and CAS No. (120 character max. Use multiple lines if needed.) Yes / No
Charge Amount
Additional
5420
Grand
Comments,
Total
Total
,
Instructions or
Shipping
5416
Requests .
Total
Form Instructions / Terms and Conditions:
-- Only current Hazardous Waste Generator trained requestors are authorized to purchase chemicals from the CSDF. Training certification is required
annually to maintain
eligibility. Please contact the EH&S Department's Environmental Health Manager to inquire about training requirements and
schedules (X3869). -- Chemical distributions will be made from CSDF stock whenever practical (same amounts, grades, and or


purity specifications).
-- An e-mail will be sent to the above listed address when the order is completed and ready to be picked up at the CSDF.
-- The

normal



CSDF

pickup

window hours

are:


Monday

-Friday, 9:00



am to

12:00

noon

1:00

and

pm to


4:00

pm.
call

Please

X3555


for

pickups

outside


of these hours.



-- The

CSDF


is located
in


Coolbaugh Hall, Room 030.

Printed forms

can

be submitted


at
the

CSDF.

--

Requesting

expedited shipping

services will incur



additional shipping

charges.

Contact

the


CSDF


for

cost

estimates.
--

Requestors must
21

be
years

of age or
older
to

purchase or pickup absolute


ethanol.


A


state

valid,

issued,

photo
ID is
for

required



proof of age.


-- Please be


prepared
to

produce
a valid CSM

photo ID (BlasterCard)

when

picking


up

from

chemicals
the

CSDF.


-- All requestors

are responsible


for

proper

transportation,

storage,

use,
disposal

and
of

Contact

chemicals.

the


CSDF


for

guidance if needed.


Print Form
Save completed form with a different name
Authorization Signature for
before attaching to email. Email completed
Banner Index Account
Date:
form to: CSDF@Mines.edu
Listed Above.
CSDFChemReqForm2013a.pdf