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<br />Chemical Storage and Handling <br /> <br />Version #: 2.2 Date Revised: 09/28/2023 Page 4 of 4 <br /> <br /> <br />Chemical Approval Form <br /> <br /> <br />Chemical Name: <br />Manufacturer Name: <br />Person Requesting Chemical: <br />Chemical Use: <br />Storage Location: <br /> <br />1. Quantity of chemical to be purchased: <br />2. How much is to be stored on site? <br />3. Departments using this chemical: <br />4. Is the chemical Food Grade: <br /> <br />Chemical request denied <br /> We do not have proper PPE on site <br /> This chemical contains allergens <br /> This chemical is a pesticide or herbicide <br /> Other: <br /> <br />No amount of chemical may be brought on site without the approval of the Safety Coordinator. By signing this <br />document, the person requesting the removal attests that the information is correct to the best of their <br />knowledge. <br /> The SDS must be submitted with this form <br /> <br />Department Manager Signature: <br />Date Signed: <br />Safety Coordinator Signature: <br /> Approved <br /> Not Approved <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />