1. This form provides the information needed to permit the University of Hawaii to properly manage our hazardous material and hazardous waste in accordance with Federal and State of Hawaii regulations. The information will also enable the Environmental Health and Safety Office (EHSO) to assist in ensuring that materials are safely stored and handled. If you have any of the materials listed below, please provide the information requested. If additional space is needed, you may use an attached sheet using the same format. If at a later date you obtain materials not previously listed, please submit an amended form.

2. Explosive materials (e.g., ammonium perchlorate, picric acid or picrates, azides, acetylides or fulminates of heavy metals, aromatic di or tri nitro compounds such as dinitrophenol or trinitrotoluene, nitroglycerine, RDX or tetrazene).

3. Water Reactive materials (e.g., alkali metals such as sodium, potassium or lithium; metal hydrides such as lithium aluminum hydride, sodium borohydride, lithium hydride; calcium carbide, ethyidichlorosilane and phosphides).

4. Flammable or Poison Gases (e.g., methane, ethylene, chlorine, phosgene, and hydrogen sulfide)

5. Organic Peroxides (e.g., methyl ethyl ketone peroxide or peracetic acid)

6. Highly Toxic Materials (e.g., cyanides, osmium tetroxide, phosphorus, strychnine, pentaborane, or any material with a LD₅₀ (oral rat) of 50 mg/kg or less).

7. Flammable Liquids (i.e., materials with a flash point of 140 degrees Fahrenheit or less) in quantities of 60 gallons or more at any one time.

PLEASE SEND THE COMPLETED FORM TO: EHSO 2040 East-West Road Attention: Environmental Compliance Officer The Environmental Compliance Officer may be contacted at 956-3198 or Fax 956-3205, if you have questions.