1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463
Termination of Laboratory Use Check-Out List
Name__________________________ Title ____________________________
Room # & Building ____________________________________________________________
Chemicals Date Completed or N/A
Check all cabinets, benches, fume hoods, refrigerators, etc. _______________
Evaluate all chemicals and label all containers _______________
Transfer responsibility of chemicals to: __________________ _______________
Evaluate all samples and label all containers _______________
Transfer responsibility of samples to: ___________________ _______________
Prepare chemical waste for shipment. Submit Montana Tech _______________
Hazardous Materials Manifest form to EH&S
Confirm that hazardous waste has been removed _______________
Clean laboratory surfaces _______________
Gas Cylinders
Return to supplier. For non-returnable cylinders, contact EH&S _______________
Or transfer responsibility to: ____________________ _______________
Microorganisms and Cultures
Autoclave waste _______________
Disposed of waste in proper manner _______________
Clean incubators, ovens, and refrigerators _______________
Transfer responsibility of samples to: _______________ _______________
Controlled Substances
Contact U.S. Drug Enforcement Agency regarding status of permit _______________
Arrange for disposal by calling EH&S _______________
Animal Tissue
Dispose of tissue. Method ___________________ _______________
Dispose of preservative. Method ___________________ _______________
Clean refrigerators and freezers _______________
Transfer responsibility of samples to: _________________ _______________
Equipment
Clean of decontaminate equipment to be left in place _______________
Contact EH&S regarding disposal of equipment _______________
Shared Storage Areas
Check all shared storage areas for hazardous materials _______________
Department Sign-Off
Researcher Signature __________________________________
Department Head Signature ___________________________
EH&S Director Signature ____________________________
Date ________________
Date ________________
Date ________________
Account to be in charge for disposal _________________________________
