Contract to purchase chemicals/gasses
This form can be used to order several chemicals or gasses of one and the same firm.
Orders can only be processed when the form is filled out completely by authorized applicants
OFI-number
Type of costs
Date:
Faculty/Institute/Agency:
Applicant:
Phone:
Final destination
Building:
Research group:
Order number:
Signature:
There are new hazard statements. If H-statements are unknown you may use the Risk sentences (R-sentences)
A
Firm:
Article number:
Amount:
Name article/material:
Cas-number:
H-statements:
Very Toxic
H300 H310 H330 (was very
toxic: R26 R27 R28)
Color: Red
Roomnr:
B
Firm:
Long-term health danger
H340 H350 H360 (was carcinogenic/mutagenic/
reprotoxic: R45 R46 R49 R60 R61 R64)
Color: Yellow
Cupboardnr:
Shelfnr:
Article number:
All H-statements (numbers) must be completed. If
one or more H-statements (or R-sentences) appear
in the fields on the left, tick also the box in the
relevant field.
Own code:
Amount:
Name article/material:
Cas-number:
H-statements:
Very Toxic
H300 H310 H330 (was very
toxic: R26 R27 R28)
Color: Red
Roomnr:
C
Firm:
Long-term health danger
H340 H350 H360 (was carcinogenic/mutagenic/
reprotoxic: R45 R46 R49 R60 R61 R64)
Color: Yellow
Cupboardnr:
All H-statements (numbers) must be completed. If
one or more H-statements (or R-sentences) appear
in the fields on the left, tick also the box in the
relevant field.
Shelfnr:
Bestelnummer:
Own code:
Hoeveelheid:
Name article/material:
Cas-number:
H-statements:
Very Toxic
H300 H310 H330 (was very
toxic: R26 R27 R28)
Color: Red
Roomnr:
Long-term health danger
H340 H350 H360 (was carcinogenic/mutagenic/
reprotoxic: R45 R46 R49 R60 R61 R64)
Color: Yellow
Cupboardnr:
Shelfnr:
All H-statements (numbers) must be completed. If
one or more H-statements (or R-sentences) appear
in the fields on the left, tick also the box in the
relevant field.
Own code:
Applicant certifies that there is in no way a conflict of interests with entering an obligation with the proposed supplier.