Environmental Health & Risk Management Department
HAZARDOUS WASTE PICKUP REQUEST
 
Waste Labelled and Properly Packaged*:             Yes              No
 
  First Name Last Name    
Requestor*:
Date:
  05/16/2008
Building*:
Lab/Room #*:
Ext*:
PI/Supervisor*:
Department*:
 
Waste Category*:              Chemical                  Biological                  Radioactive
 
Identification/Description of Waste
(write chemical name, not formula)
Solid Liquid Gas LSV
Number, Size & Type of Container
(ex: 3x1 L. bottle)
   
 
Waste Notes and/or handling instructions:
             
RAD Waste Replacements:
   RAD Bags #
Carboys #
Sharp Tubes #
Biological Waste Bag Replacements:
Preferred Pickup Day:
        AM      PM 
Note:
  Give 24 hours for pickup. No same day service.