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Environmental Health & Safety
Hazardous Waste Pick-up Request Form

Principal Investigator:

Person Requesting Pick-up :

Telephone:

Department:

     Email:

Building:

         Room # :

Name Quantity Units Replacement Container
Chemical
Biological
Isotope Activity (µCi) Replacement Container
Radioactive

Please note, our goal is to pick up your waste as soon as possible and in no more than 3 days.  We will attempt to contact you if we will be delayed.  If you require immediate assistance, please let us know in the comments field.

Additional Comments:

Environmental Health & Safety
Hazardous Waste Pick-up Request Form

Principal Investigator:

Person Requesting Pick-up :

Telephone:

Department:

     Email:

Building:

         Room # :

Name Quantity Units Replacement Container
Chemical
Biological
Isotope Activity (µCi) Replacement Container
Radioactive

Please note, our goal is to pick up your waste as soon as possible and in no more than 3 days.  We will attempt to contact you if we will be delayed.  If you require immediate assistance, please let us know in the comments field.

Additional Comments:

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Last Modified 5/13/11

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