Controlled Substance Disposal Request Form Your pickup will be scheduled within a week of submitting this form. Please call the Controlled Substance Program at (617) 638-4510 if further clarification is needed.Check One:* Expired Unwanted Controlled Substance Department* Campus* Boston University Medical Campus (BUMC) Charles River Campus (CRC) BUMC Building*Biosquare IIIE Building-Evans BuildingK Building-Conte Research BuildingL Building-Instructional Building620 Albany StreetR Building-Housman Research BuildingW Building-CABR BuildingX Building-EBRC BuildingCRC Building*2 Cummington Mall8 St. Mary's Street24 Cummington Mall36 Cummington Mall44 Cummington Mall590 Commonwealth Ave610 Commonwealth Ave635 Commonwealth AveRoom* PI/Authorized Registrant* Name of person to call for questions* Email* Phone*Substance DescriptionControlled Substance NDC #: Drug Schedule: Number of ContainersConcentration Volume Lot Number Expiration Date MM slash DD slash YYYY PO Number Controlled Substance NDC #: Drug Schedule: Number of ContainersConcentration Volume Lot Number Expiration Date MM slash DD slash YYYY PO Number Controlled Substance NDC #: Drug Schedule: Number of ContainersConcentration Volume Lot Number Expiration Date MM slash DD slash YYYY PO Number Controlled Substance NDC #: Drug Schedule: Number of ContainersConcentration Volume Lot Number Expiration Date MM slash DD slash YYYY PO Number Controlled Substance NDC #: Drug Schedule: Number of ContainersConcentration Volume Lot Number Expiration Date MM slash DD slash YYYY PO Number Document your logbook. Surrender all expired/unwanted drugs to csp@bu.edu.NameThis field is for validation purposes and should be left unchanged.