UC Irvine Laboratory and Animal Research Controlled Substances
Disposal Request

Any person in possession of any controlled substance is required to follow appropriate disposal procedures. Complete the form below to request a pick up by an approved and authorized representative from EH&S. The animal protocol number and copies of inventory utilization (if available) will be requested at the time of pick up.

Disposal Information:
*required fields

*Name: (first) (last)
*Phone:
*Principal Investigator or Supervisor: (first) (last)
*Department:
*Building (Pick up location for unit):
*Room (Pick up location for unit):

E-Mail:

Item Information:
Research Protocol number (if applicable):

Drug Information (if applicable) (e.g., type, quantity ):

Additional Information:

PRINT a copy for your records BEFORE clicking the “Next” button.