Registrant Name (Print): Laboratory Location - Building: Room Number: **I hereby certify that I have designated the person(s) listed below as Authorized Users for this location. A person is no longer an Authorized User when a Departed” has been entered. “Date Initials UVA Date Date Name (Print) Signature Used on Computing **Registrant Signature Departed Logs ID 10/15/2016 Angela Gamble SAMPLE ONLY ARG ADR8S 10/19/2016
Registrant Name (Print): Laboratory Location - Building: Room Number: **I hereby certify that I have designated the person(s) listed below as Authorized Users for this location. A person is no longer an Authorized User when a “Date Departed” has been entered. Date Name (Print) Signature Initials Used on Logs UVA Computing ID Date Departed **Registrant Signature 10/15/2016 Angela Gamble SAMPLE ONLY ARG ADR8S 10/19/2016