STATEMENT OF (NON)BIOHAZARD
POTENTIAL CONTAMINANTS: Check off and/or list all substances in the following categories that might have come in contact with the instrument. Full disclosure, please - anything that might have been in, on, or around this instrument.
1.
ISOTOPES (please specify)
_____ _____ _____ _____ _____
2.
TOXINS
Acrylamide _____
Other __________________________________________________
3.
MUTAGENS
Ethidium Bromide _____
Other __________________________________________________
4.
BIOLOGICAL
Bacteria ____________________ Virus ______________________
Blood, tissue, body fluids _______________________________
Other __________________________________________________
5.
OTHER SIGNIFICANT SUBSTANCES (other than air or pure water)
____________________________________________________________
DECONTAMINATION: I certify that this instrument has no detectable levels of the potential contaminants listed above.
Signature: ______________________________ Date: ______________
Print Name: _____________________________ PI _________________