Chemical Safety Waste Pick-up Form

Date: 11/18/2018

Please reference the Chemical Disposal Fact Sheet for information on chemical pick-ups.

Click here if you need chemical tags sent to you...

E-mail Address (required to begin)

* Your E-Mail Address

Your e-mail address will allow you to complete your task over several sittings, if necessary. Entries are saved as you type. If you browse away from a partially-completed form and return to an empty form, enter your e-mail address and press "Tab".
("Finished" work is not available to restore.)

My Information

* Your First Name

* Your Last Name

* Department:

* Building:

* Room:

* Phone Number:

* Supervisor:

Comments:

Enter Your Chemical Waste Items (To enter more than one chemical pick-up, press "Add Another Chemical Tag".)

NOTE* If you have multiple containers of the same chemical constituents or are cleaning out a laboratory area, please contact EHS at 9-4386 for specific instructions prior to filling out form or collection tag.

* Chemical Collection Tag #

* Container Size

* # Containers

* Chemical Name(s) / Percent (must equal 100%)

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