a list of what you are leaving behind

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Samples.doc samples list.
Containers of materials you are leaving.
your name ____________________ Date _________
Page _____ of _____
revised February 2015 https://www.chem.purdue.edu/chemsafety/Files/samples.docx
Any and all containers of chemicals and mixtures (including peptides, aqueous solutions, buffers, washes, tissue cultures, and/or
synthetic samples) that you are leaving at Purdue -- NOT INCLUDING THOSE IN MANUFACTURERS’ CONTAINERS – in a cabinet or
hood or drawer or refrigerator or freezer…. -- must be accounted for here. Including anything taken possession of by your professor or
another group member. Repeat: this applies only to materials which are not in original manufacturers' containers. The
manufacturers’ containers generally have completely adequate labeling and usually do not become unknowns, so they are not of
concern here.
You are to leave behind only what your supervisor has signed (initialed) for in the list. If any material’s identity is sensitive
(confidential/proprietary) it will be acceptable to omit chemical identification from the list and use a code that is associated with the
container label. Hazard characteristics must be identified on this list for all items.
The safety officer is likely to ask to see inspect container labels containers during the work area checkout appointment.
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Can it detonate or
deflagrate
oxidizer
pyrophoric
See Table next page or reverse.
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Advisor initial here to
indicate requirement to
keep.
Name any/all “EPA Toxicity Characteristic”
element(s) or compound(s)
Combustible
(100 oF < fl pt < 200 oF)
Water reactive*
Chemical name or mixture
composition (%s) and other label
markings or codes, or
“confidential/proprietary
Label code __________”
How many containers
Amt each container
Storage location
(precisely)
Flammable (fl.pt < 100 oF
Container labels must remain legible for as long as the contents remain in the container.
N
N
N
N
N
N
N
N
N
N
N
* water reactive = contact w/ water produces flam gas (e.g. H2) or toxic or corrosive gas (e.g. HCl) and/or violent energy (e.g. fuming nitric acid)
EPA Toxicity Characteristic elements and compounds.
Any mixture or pure or substance which is or contains any of these elements or compounds is to be identified in the samples list by
adding the name(s) of the element(s) or compound(s). Note that a few are rather common metals and solvents.