A-State

(*) denotes required information.

FOPL Account Number:

Researcher's First Name:

Researcher's Last Name:

Department:

* Email Address:

Contact Name:

Telephone:

Location of Waste:

Building:

Room Number:

Area:

I certify that the waste is described, sealed, and labeled.

Name:

Date:

Proper Chemical Name:

INSTRUCTIONS

A. Label the Waste:
Attach the "Hazardous Waste" label to each container. Be sure to fill out the label completely.

B. Complete the following list:
1. For unknowns:
In the "Proper Chemical Name" column, list the waste as "Unknown A," "Unknown B," etc. Mark the "Hazardous Waste" label "Unknown A, B, " etc.
2. For contaminated dry waste:
Describe the waste in the "Proper Chemical Name" column. Indicate the total weight of the waste in the "Amount Wt./Vol." column
3. For mixtures:
Write "Mixture" as the "Proper Chemical Name." List each chemical on a separate line on the "Hazardous Waste" label, and indicate the percent content by volume.
4. For pure chemicals:
Write the full chemical name in the "Proper Chemical Name" column. Do not abbreviate, draw structures or give brand names.
5. In the "Physical State" column, choose either "solids", "liquids", or "gas".
6. In the "Amount" column, state the amount in either pounds or gallons
7. Copy the item number from this list onto the "Hazardous Waste" label.

C. For pick-up:
When you are finished entering your waste information below. Click on "Submit Pick-up Request" to send your request to the EH&S Hazardous Waste Management staff.

Waste Information (do not use abbreviations, formulas, or brand names)

Physical State: Solid Liquid Gas

Number of Containers: 1 2 3 4 5 6 7

Amount:

Weight/Vol. Pounds Gallons

Chemicals in Mixture:

If you have any questions or comments regarding your chemical waste, please state them in the space below:

*Validate Image:

Waste Disposal Request

Chemical Waste Disposal Request Form