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Last updated: July 11, 2012 Controlled Substances Single Drug Disposition Record Date: _________________________________________________________________________ Unit Registrant Name: ___________________________________________________________ Building and Room Location: ______________________________________________________ Location of safe: ________________________________________________________________ Drug Name: _______________________________________ Schedule: _______________ (I-V) Form (liquid, tablets, patch, etc.): __________________________________________________ Concentration: _________________________________________________________________ Expiration date: ________________________________________________________________ Dilution or combination (mg/ml): __________________________________________________ Total initial volume: _____________________________________________________________ Date Quantity used Balance remaining Use Information Initials Research information, e.g., animal wt