Form D – Environmental Compliance Assessment
(Internal form to be used for discussion with the UI Environmental Compliance Manager)
Briefly describe your research project.
Will the project include any source of emissions or exhausts to the atmosphere such as:
Fume hoods
Yes
No
Boilers
Yes
No
Generators
Yes
No
Sterilizers
Yes
No
Combustion sources
Yes
No
(list the source and the fuel)
Will any equipment use ozone depleting substances such as freon, hydrochlorofluorocarbons,
chlorofluorocarbons (e.g., chillers, freezers)
Will you have 55 gallons or more of oil of any kind in any containers or equipment?
If any of the following will be discharged into the sewer, check the appropriate box(es).
Flammable or explosive pollutants
Corrosives
Solid or viscous pollutants that may cause obstructions of flow
Pollutants capable of releasing fumes or vapors
Pollutants of high biological oxygen demand
Oil of any kind
Will any pollutants of any kind be discharged into a surface water?
Will hazardous waste be generated?
Yes
No
How will it be handled and disposed of?
Will any mercury containing equipment be used?
Will any pesticides be used?
Will hazardous materials be present?
Yes
No
Has Hazardous material storage been addressed?
Meeting and Review with Environmental Compliance Manager
___________________________________
Signature
(date)
_________________________________
Signature
(date)