Lab Relocation or Closure Notification

Use this form to notify Environment, Health & Safety three weeks prior to:
  • Relocating your lab to new facilities, on or off campus
  • Permanent closure of your lab

Timely submittal of the form allows update of records required by granting and regulatory agencies, and will permit continued use of materials, such as radioisotopes, without interruption.
Contact Information
Principal Investigator:
Old phone:
New phone:
PI's e-mail address:
 PI's new mail code:
  
Lab Manager:
Old phone:
New phone:
Lab Manager's e-mail address:
Lab's new mail code:
  
Department:
 Date of move:
  

Old Laboratory Locations
Building:
 Rooms:
Building:
 Rooms:

New Laboratory Locations
Building:
 Rooms:
Building:
 Rooms:

Hazard Information
Radioactive materials?
Yes     No		 If so, provide the Radioisotope Use Authorization number:
Biohazardous materials?
Yes     No		 If so, provide the Biohazardous Use Authorization number:
Controlled Substances?
Yes     No		 If so, provide the Controlled Substances Use Authorization number:
Hazardous chemicals?  Yes    No

Equipment to be cleared
In the comments section below, list the quantity and type of equipment to be cleared.
Example: "I have one refrigerator/freezer unit used to store
radioactive and biohazardous samples."
Review the information above. If correct, click "Send"
and your request will be e-mailed to Environment, Health & Safety.


Questions?
Contact EH&S Research Safety, (858) 534-6138
Environment, Health & Safety Office
University of California, San Diego