Doh 2340-2026

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4.8 out of 5

52 votes

The document is a request form for the approval of the disposal or destruction of controlled substances, issued by the New York State Department of Health's Bureau of Narcotic Enforcement. It outlines the necessary information required for submission, including details about the licensee, method of disposal, and personnel involved. The form emphasizes compliance with federal, state, and local laws and specifies that disposal must occur on weekdays during designated hours. It also includes sections for affirmation and post-disposal confirmation.

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Click ‘Get Form’ to open the doh 2340 in the editor.
Begin by filling out SECTION I – REQUEST INFORMATION. Enter your Licensee Name, ensuring to include a street address if using a P.O. Box. Complete the fields for Street, City, State, County, Telephone, Email Address, Zip, and Fax.
Input your Controlled Substance License # or DEA registration number if applicable. Specify the Date of Disposal/Destruction and select an appropriate Start Time (AM/PM).
Detail the Method of Disposal/Destruction and provide the Location of Disposal/Destruction including room number or name.
Have the Personnel Conducting Disposal/Destruction fill in their Name, Title, and Professional License #.
In the REQUESTOR AFFIRMATION section, affirm that you will dispose of/destroy controlled substances as proposed by signing and dating the form.
After disposal/destruction is completed, complete SECTION II by having personnel sign and date to confirm compliance with regulations.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (52 Votes)
2010	4.4 Satisfied (326 Votes)

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Doh 2340-2026

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Doh 2340-2026

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