Environmental Health & Safety

Request for Chemical Waste Pick Up

Please carefully label and identify the chemicals you would like to be picked up. Fill out the form as completely as possible, listing the name of the chemical and the quantity. This request will be assigned to our safety technician who will schedule a pick up. Forms which are not completed properly will result in delayed pick up.

Instructions:

  1. Please fill out form completely - incomplete forms will result in pickup delays.
  2. Room must be the location of the waste.
  3. Chemical Waste Labels must be affixed to containers.
  4. Chemical Name must be the actual chemical name. Formulas and abbreviations cannot be used.
  5. Give quantity and units (e.g. 5 gallons).
  6. Press the submit button
Principle Investigator: Date:
Department: Phone:
Building: Room:
Contact Person:
Email:
Number of items on this Pick-up:
If the waste is a mixture, please list all chemicals on same line.
1. Chemical Quantity
2. Chemical Quantity
3. Chemical Quantity
4. Chemical Quantity
5. Chemical Quantity
* Security:

Enter the code below, including spaces, as it appears to the right.

10 twentyone 2014
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