Complete this form to request ethanol from Safety Services.

Distribution will occur the following Wednesday morning at
10:00 AM, unless alternate arrangements are made. If there are any problems or exceptions, the Safety office will contact you at the number provided.

Important Note: The information entered must be accurate.

If you have any questions, please contact the Safety Services office:
Lubbock: (806)743-2597
El Paso: (915)783-5245

Pickup Locations: To view a map to the alcohol distribution room for your campus, please login. (Note: Signing-in will reset the form. Basic user information will be automatically entered.)

Please Enter the Following Information

Today's Date and Time: Wednesday, October 26, 2016 12:17 PM

Requestor Information

  First Name
  Last Name
  Contact Email Address
  Phone Number
  PI Name
  PI Lab Room #
  Account # (FOP)
  Action:    Purchase Container Refill       Purchase Pre-filled Container
  (Check all that apply.)

Container Refilling


Pre-filled Containers

  Orders  (Unit Volume Per Proof)
Click [?] For Help.


Container Refilling HelpHelp

Use this section if you have a container for refill.

Complete a separate line for each container that you are refilling.

Note: The volume requested must be in Gallons. If the known amount is in Liters, use the pop-up "Liters -> Gallons Conversion Tool". It will automatically convert the amount to gallons.

Otherwise, ignore the pop-up conversion tool and enter the amount in gallons.

Prefilled Container HelpHelp

Use this section to order pre-filled containers of ethanol.

Indicate separate orders for each volume per type.

Containers are available in Gallon and Pint sizes.