Gas Cylinder Return Request Form

Indicates required field

Please use this form to return gas cylinders. If you have questions, please contact Receiving Services at (951) 827-5392.

First

Last

Phone

Pickup Location

Please indicate if the location is alarmed, has gate or elevator access.

Physical Address

Building

Notes

Quantity & Status

Cylinders must be from Receiving Services (Airgas or Matheson) only. Other cylinders require prior authorization by Receiving Services. For credit, please provide COA.

Number of Empty Cylinders

Number of Return for Credit

COA (Chart of Accounts)

Entity

Fund

Activity

Account

Function

Program

Project

Flex 1

Flex 2

Notes

Comments

Campus Business Services

Gas Cylinder Return Request Form

Pickup Location

Quantity & Status

UCR Campus Business Services (CBS)