Request for Hazardous Waste Pick-Up To:* From:* Email Address:* Location of Waste (Building & Room Number)* PI:* Waste Container 1-List all contents in waste container* Quantity and Size of Container* Hazard Class (i.e. corrosive, toxic, flammable, reactive, none)* Do You Have Another Waste Container to Dispose? Yes No Waste Container 2- List all contents in waste container* Quantity and Size of Container* Hazard Class (i.e. corrosive, toxic, flammable, reactive, none)* Do You Have A Third Waste Container to Dispose? Yes No Waste Container 3- List all contents in waste container* Quantity and Size of Container* Hazard Class (i.e. corrosive, toxic, flammable, reactive, none)* Supplies Needed (Use dropdown menu below description to indicate quantity needed):1 gallon wide mouth container (solid waste only)0123454 liter plastic jug (for liquid wastes)012345500 ml plastic bottles for waste012345 gallon polyethylene jerrican (only for the following wastes: solvents, photo fixer/developer and formalin waste)0123455 gallon pail0123455 gallon pail liner012345Hazardous waste labels012345678910111213141516171819202122232425Containment tray012345SAA sign01234Additional commentsNameThis field is for validation purposes and should be left unchanged. Δ
