TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
DEPARTMENT OF SAFETY SERVICES: ENVIRONMENTAL SAFETY
NARCOTICS DISPOSAL
DEA CLASS 1,2,3,4, OR 5
 
Requestor: Department:
Building/Room: Phone:
Date: 5/21/2012 Time: 7:07 AM

Region:

Safe Question: (what is 7 + 6?)
DEA Registration Number DEA License Holder Name

Narcotic
Common Name		 Drug Form
(eg. liquid, powder, tablet)		 Container Type
(e.g. glass, plastic)		 No. of
Containers

Comments:


Note: All containers must be capped/sealed and LABELLED or they will not be picked up.


Submit additional form if you have more than 10 drugs to transfer.