Chematix Laboratory Listing Request Form

Complete this form to have a laboratory listing inserted into Chematix. 

Please enter the four digit building number (as designated by Facilities Management).
Please enter the room number for the lab location (one room number per request form).
Enter the faculty member's university email address.
Select yes if all current laboratories in Chematix for the indicated room number should be archived.
Select yes if the new lab will inherit all of the existing chemical inventory from the lab listing it is replacing.
Select the option that describes the status of chemical waste for the new lab listing.
Please list email address you wish to receive copy of this request.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.