Registered Location Closeout Notification Form

  1. Registered User (Required)
  2. RU Number (Required)
  3. Phone (Required)
  4. Email (Required)
  5. Department (Required)
  6. Chairperson: (Required)
  7. Email: (Required)
  8. Primary Contact (if not RU):
  9. Phone:
  10. Email:
  11. Secondary Contact
  12. Phone
  13. Email:
  14. Reason for Cleanout: (Required)

    Explanation for Reason 5

    Moving date for Reasons 1 or 2 / Final date at University for Reasons 3 or 4

    For Reasons 1 or 2: New Location(s):
  15. Old Location(s): (Required)
    List all rooms that you would like removed from your registration.

    Building Coordinator(s): (Required)
  16. Please indicate with a slash (/) which materials or equipment are applicable to your location (the one you are vacating): (Required)

  17. Biological and Select Agents
    Biological Safety Cabinets
    Compressed Gas Cylinders
    Controlled Substances
    Fume Hoods
    Radioactive Materials
    Hazardous Materials-used
    Hazardous Materials-unused
    Hazardous Materials-unknowns