Hazardous Waste Pick-up Request


Please enter all information requested below and click on the "submit" button to complete request.

Please provide the following contact information:

Name
Title
Work Phone
FAX
E-mail

What is the building number where the waste is located?


What is the room number where the waste is located?


What type of container is the waste in? (select any of the following options that apply):

Glass
Plastic
Carboy
Safety Can
40 gal. Drum
55 gal. Drum

What category of waste do you have? (select any of the following options that apply):

Halogenated Solvents
Non-halogenated Solvents
Organic Acids
Inorganic Acids
Organic Bases
Inorganic Bases
Heavy Metal
Reactives

How much waste do you have? Choose one of the following options:

Less than 1L
Between 1L and 4L
Greater than 4L

Have you filled out a hazardous waste tag for the items to be picked up?

Yes No

Proper tags are tan in color and have SH0 FORM 15-13 in the lower right hand corner. Please call ext.4055 if you need the new tags.

(NOTE: Forms must be filled out completely for your waste to be picked up. The common chemical name on the MSDS sheet for the chemical must be used - not the formula.

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