Appendix F - Notification Forms
Notification of the Usage of
Acutely Toxic, Carcinogenic, or Reproductive Hazards
Please complete this form and return it to the Environmental Health Office.
Lab Supervisor/Lead Instructor:
Notification: In accordance with the requirements of the Chemical Hygiene Plan, this document serves as notification to Environmental Health of the use of the following class(es) of chemicals:
Carcinogens or suspected carcinogens
Acutely toxic chemicals
Statement of compliance
I have reviewed the requirements of the College’s Chemical Hygiene Plan and the applicable Standard Operating Procedures as they apply to carcinogens, acutely toxic chemicals, and reproductive hazards, and have complied with all applicable requirements, to the best of my knowledge and to the extent feasible.
Director, Environmental Health
San Juan College
4601 College Blvd.
Farmington, NM 87401