Environmental Health and Safety

2809 Daley Drive

Ames, Iowa 50011-3660
Phone: 515 294-5359
Fax: 515-294-9357
www.ehs.iastate.edu

Application for Permission to Obtain Tax Free Ethanol

Forward completed application to Environmental Health and Safety, or fax to (515) 294-9357. Unless
otherwise indicated please print all information.
Applicant Name

Russell Mahmood
____________________________________

ISU ID Number

320554234
____________________________________

Department

_____________________________________

Principal Investigator/Manager

Dr. Andrew Hillier

_____________________________________

Account Number

555-02-02-003673
_____________________________________

Chemical and Biological Engineering

The undersigned agrees to the following terms and conditions for the withdrawal and use of tax-free ethanol:
1. Applicants will ensure strict compliance with all laws of the United States, as put forth by the Alcohol
and Tobacco Tax and Trade Bureau of the U. S. Department of the Treasury, relating to the
manufacture, taxation and control of tax-free ethanol as well as the laws of the State of Iowa.
2. The amount of tax-free ethanol withdrawn from storage will be the minimum quantity practicable.
3. All tax-free ethanol withdrawn will be secured under lock and accessible only to the Principal
Investigator or Manager and their designated employee(s).
a. Building location:

Sweeny Hall, 3rd Floor

_____________________________________

b. Room Number:

3060
_____________________________________

4. An accurate written inventory of the ethanol, as it is consumed, will be maintained with the ethanol by
the authorized person.
5. The use of tax-free ethanol will be restricted to the Iowa State University premises and in no instance
will tax-free ethanol be used in the manufacture or preparation of food products or beverages.
6. Research products, reagents, dilutions and veterinary pharmaceuticals that contain tax-free ethanol will
be restricted to the Iowa State University premises.
In order to obtain tax-free ethanol the authorized person must present photo identification at time of
withdrawal.
Undersigned has completed Tax-free Ethanol Training.
Digitally signed by Russell Mahmood
DN: cn=Russell Mahmood, o=Iowa State University, ou,
email=russell7@iastate.edu, c=US
Date: 2015.06.25 11:00:05 -05'00'

Signature of Applicant

________________________________________

Date

25th July 2015

____________________

EH&S Approval
Signature

________________________________________

Date

____________________
Reviewed 2015