U-market services order for alcohol

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EFS Purchase Order/Blanket Order #
2901 Talmage Avenue S.E.

Minneapolis, Minnesota 55414

PH: (612) 624-4878


Please provide the following information each time alcohol is ordered.

1. What is the estimated amount of alcohol used per month? _______ Pints / Gallons (Circle Size)

2. What is the average amount of alcohol in storage per month? _______ Pints / Gallons (Circle Size)

3. Please circle type of storage for alcohol: Chemical Storeroom / Fume Hood / Flammable Storage Cabinet

4. Is the Laboratory / Cabinet locked when not attended? _____Yes _____No

5. Alcohol is stored in the following Room and Building: ____________________________

6. Will this alcohol be redistributed to other users or locations within the University? _____Yes _____No

7. Person ordering alcohol is authorized to place the order? _____Yes _____No

Authorized Department Signature_________________________Auth. Dept. Signature X.500_______________

**Signature acknowledges important information listed below.
Fax: (612) 624.5778 Date ________________

**Alcohol to be used exclusively for education, scientific research or medicinal purpose only**


Quantity Stock # Units Description

__________ CX20442 Pint /Each 200 Proof Ethyl Alcohol (24 Pint/Case)

__________ CX20445 Gallon/Each 200 Proof Ethyl Alcohol (4 Gallon/Case)

__________ CX20460 5 Gallon 200 Proof Ethyl Alcohol (Each)

__________ CX20457 Gallon /Each 190 Proof Ethyl Alcohol (4 Gallon/Case)

__________ CX20461 5 Gallon 190 Proof Ethyl Alcohol (Each)

__________ CX20458 54 Gallon/Drum 190 Proof Ethyl Alcohol (Drum/Each)

__________ CX20446 54 Gallon/Drum 200 Proof Ethyl Alcohol (Drum/Each)
Delivery Address (Please Print)

Department Name: ______________________________

Room and Building: ______________________________

Person Placing Order: _______________________________ Telephone Number________________

Person Placing Order X.500: _______________ E-Mail Address: ______________________________


**Important Information:

This form must be completed, and faxed or mailed to U-Market @612-624-5778 before any alcohol can be issued.

U-Market Services holds the U of M site licenses for alcohol purchases with the Federal Bureau of Alcohol, Tobacco, and Firearms (BATF), and is responsible for maintaining a list of customers and the volume of alcohol delivered to each location for audit purposes.

Departments are responsible under penalty of law to assure that alcohol is used exclusively for education, scientific research, or medicinal purposes. Disposition records must be maintained by departments for any alcohol transferred to a University of Minnesota room and building not listed above. This is required by the Federal Bureau of Alcohol, Tobacco, and Firearms (BATF), and departments risk substantial tax penalties for not maintaining this information.

Departments are not allowed to transfer any alcohol outside the University of Minnesota for any reason.

U-Market Services will forward a quarterly report of alcohol purchases to Environmental Health & Safety (EH &S), as well as copies of these order sheets. This information will be used by EH & S to verify storage, security, and safety of alcohol in departments.

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