Chemical Approval
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Requestor Name:
Requestor Contact no:
Requestor email:
Department:
Date:
Product Name (per SDS):
Product Manufacturer (per SDS):
Synonym(s) (if known):
Product Ingredients (Per SDS)Product CAS RN (Per SDS)Product Composition (Per SDS) 
Oxygen 7782-44-7 0.5%
Helium 7440-59-7 0-100%
Nitrogen 7727-37-9 0-100%
Argon 7727-37-9 0-100%
Oxygen 7782-44-7 <23.5%
Carbon Dioxide 124-38-9 <20
Hydrogen 1333-74-0 <1%
Carbon Monoxide 630-08-0 <0.3%
GHS Classification (Per SDS)
GHS Signal words (Per SDS)
GHS PICTOGRAM (Per SDS)
Chemical Hazards (Per SDS)
Precautionary statement (Per SDS)
English SDS Upload:
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17 He_Ar_N2_O2 less 23.5_CO2 less 20_CO less 0.3_H2 less 1 Exp 03 Dec 2024.pdf
SDS Effective Date:
Chinese SDS Upload:
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SDS Effective Date:
Flashpoint
Auto Ignition temperature
pH
Physical State
Classification
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Incompatibles listed on SDS
(Please specify if metals)
(Please specify if others)
Where will the chemical be used?
Describe the process the chemical will be used in
Estimated Quantity to be used per month
Container size:
Lumileds Part No:
Requestor's declaration for the below information are to his/her knowledge
1. Will the Chemical be retained on LUMILEDS' product?
2. Will the chemical be used as cleaning/demolder/degreaser?
Please attached the below document if applicable
a) Supplier Disclosure Form
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b) Test Report/Supplier Declaration Form
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EHS Use Only
Licencing Requirement:
Does the chemical require license from regulatory body?
Agency:
(Please specify if others)
Other EHS Considerations:
EHS Approval:
Date:
Reason not approved:
EHS Remarks:
OTher EHS Considerations:
EHS Approval:
Date:
Reason not approved:
EHS Remarks:

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