Environmental Health & Safety

Request for Chemical Waste Pick Up

Please fill out the form as completely as possible, listing the full name of the chemical and the quantity. If you have any questions, please contact EH&S at x4150.

Instructions:

  1. Please fill out form completely - incomplete forms will result in pickup delays.
  2. Please indicate exact location of waste: e.g. fume hood, lab bench, cabinet.
  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:
Location of Waste: 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
6. Chemical Quantity
7. Chemical Quantity
8. Chemical Quantity
9. Chemical Quantity
10. Chemical Quantity
Comments (optional):
* Security:

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

12 one 2023