CBC Report Request form:

This form will be submitted to the Stanford University Fire Marshal's Office at Environmental Health and Safety. Any questions or additional information should be directed to Aaron McCarthy at amccarth@stanford.edu. In general, the turnaround time for CBC reports is approximately three weeks.

FIELDS WITH AN ASTERISK (*) MUST BE FILLED OUT. USE N/A IF UNKNOWN OR NOT APPLICABLE.

Please use the TAB key only to move between the fields.

*Name of person Requesting *Requester's
Phone
*Requester's e-mail    
*Project Name *Project #
*Building Name *Building #
Planned occupancy Type: *Account#:

Reason for Report (check all that apply)

Formulation Study Move PI Remodel
New Building New PI Other

If other please describe:

Stanford Fire Marshal staff member assigned to this project

Project Owner Representative

Name Phone
Architect
Name 		Phone
Architectural
Firm		 Drawings are available at

Fully Sprinklered Building Yes ---- No

Flammable Cabinets Used Yes ---- No

List the names of Principal Investigators (PI's) involved in the project and where they are moving from and to. Text can be longer than the field size on the screen.

If the project involves laboratory moves, complete move information is required before a report can be generated. Information for at least one PI is required to transmit the form. If you choose not to or are unable to finish completing the "From/To" table at this time, a complete room move matrix must be provided to Joe Leung via e-mail before a report can be generated.

N° Name Building moving from Rooms
moving from		 Building moving to Rooms
moving to
1*
2
3
4
5

Note: If more than 5 persons moving, send spread sheet to Aaron McCarthy at amccarth@stanford.edu

Number of control areas involved in this project:

Total number of control areas in this building:

Additional Information or Comments:
(User must press Return to move the insertion point to the next line in the text area)

If you also need to submit additional chemical inventory items you may send it separately as an attached file by e-mail to Aaron McCarthy.