Permit Request • CampusOptics

Equipment that has been used with hazardous materials must be decontaminated before it can be discarded, moved, repaired, or recycled.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Name* Required

Additional Location Details

Building and Room #:* Required

Equipment Description: * Required

Manufacturer & Model #: * Required

Serial Number * Required

A&M-SA Equipment Tag# (if applicable):* Required

If you choose Other on the previous question, please specify why: * Required

If this is being discarded, indicate how it will be disposed of: * Required

Indicate who will be processing this equipment: * Required

This equipment: * Required

This equipment has been cleaned with (Describe the process/cleaning agent used): * Required

Name of Person Performing the Cleaning * Required

Title * Required

Name of PI or Department Administrator:* Required

Department Name: * Required

Add files to upload as supporting documentation along with your permit request.

Files