Chemical Pickup Request

Quick Links
	Fact Sheets
	Forms
	Guides
	Training
	Waste Disposal

CEHS Sections
	Enviro Compliance
	Lab & Haz Waste
		Biological
		Chemical
	Occ Health/Safety
	Radiation Safety
__
CEHS Information
	About CEHS
	Awards
	Feedback
	Links
	News
	Safety Committees
	Search
	Staff Directory

Lost? Use the

Chemical Pickup Request Form

Name:		Phone:
Department:
E-mail*:
Building/Room#:

*: Email address is required, staff will not receive form if email is not entered

PLEASE NOTE: Make sure all waste containers are labeled with a CEHS yellow hazardous waste label prior to collection. Waste containers without this label will not be collected. If you need labels or have any questions regarding collections, please contact us by completing the comment section at the bottom of this form.

Instructions for completing this form

# of Containers	L=liquid S=solid G=Gas	Spent=Spent Redist.=Redistributable Unused=Unused	Chemical Name(s); indicate concentrations, if applicable (grams/liter, %, ppm, etc.)	Weight (lbs)
Examples of Properly Completed Information in Red
4	Liquid	Spent	Toluene, chloroform, benzene, 2 butanone, methyl ethyl ketone	4
2	Solid	Unused	Acrylamide	5

Comments

To submit the form, press this button:

To continue adding chemicals, press the submit button above to transmit the chemicals listed and then click the 'back' button on your web browser to enter more chemicals. This will keep you from having to re-enter the contact information.

To clear the form, press this button: