UC Irvine Refrigerator and Freezer Collection Request

Pickup Request Information: *Required fields

*Name: (first) (last) *Phone:   E-Mail: *Principal Investigator or Supervisor: (first) (last) *Department: *Building (Pick up location for unit): *Room (Pick up location for unit): *Account: *Fund: Item Information: *   Refrigerator   Freezer UCI Property Number: *Serial Number: 1. Has this unit been used to store radioactive materials? Yes No If YES, has it been surveyed by the EH&S Radiation Safety Group? Yes No 2. Has this unit been used to store chemical hazardous materials? Yes No If YES, has residue been cleaned? Yes No 3. Has this unit been used to store biohazardous materials? Yes No If YES, has the unit been decontaminated? Yes No Additional Information: