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AR-EHS Chemical Request Form

Please complete the form below for all chemical requests.

Name of Person Requesting Chemical:
Date:	Building:	Room Number:
Supervisor Name:
Supervisor Phone:
Chemicals and Quantity Requested:
Email Address: (Required)
By pressing "submit" below, I certify that the above named person has given permission to obtain the above listed chemical(s) from AR-EHS. I also certify that the MSDS and proper PPE for the requested chemical(s) are available in the laboratory where work is being performed, and that the above named person has been informed of the hazards associated with the requested chemical(s).

In accordance with T.A.C. Rule §206.74, with few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected by forms.