Chemical/Hazardous Waste Pickup Request Form

Date*:

Campus*: select Main Lake Cox Research Park

Requested By*:

Email*:

Phone*:

Building*: select Allyn Hall Biological Sciences I Biological Sciences II Brehm Laboratory Campus Services Building Child Development Center Creative Arts Center Diggs Laboratory Fawcett Hall Health Sciences Mathematical and Microbiological Sciences Medical Sciences Millett Hall Nutter Center Oelman Hall Rike Hall Russ Engineering Center Student Union University Hall White Hall

Lab/Room #*:

Click here if only requesting containers/supplies

Chemical/Hazardous Waste Description

Phase*: select Solid Liquid Gas Mixture Other

Size of Container*: select 2.5 gal solvent can 5 gal solvent can Small infectious waste box Large infectious waste box 4 gal Fixer container Other    Other:

Chemical Name*:

Location of Waste*:

Replacement Containers/Supplies Needed

Amount Requested

2.5 gal solvent container: select 1 2 3 4 5 6 7 8 9 See comments

5 gal solvent container: select 1 2 3 4 5 6 7 8 9 See comments

Small Infectious Waste Box: select 1 2 3 4 5 6 7 8 9 See comments

Large Infectious Waste Box: select 1 2 3 4 5 6 7 8 9 See comments

4 gal Fixer: select 1 2 3 4 5 6 7 8 9 See comments

Comments/Special Instructions:

Important Information

Cardboard Sharps (AKA–Brokeglass) boxes–
EH&S does not service or supply cardboard sharps boxes. When a cardboard box is full, please close the lid and place it in the hallway for pickup by Physical Plant. To schedule a pickup, call (937) 775-4444.

Radioactive and Mixed Waste–
For information or service options regarding radioactive and mixed waste, please contact the Radiation Safety Office at (937) 775-2169.

First, verify that all chemicals meet the following conditions*:

Containers have all components listed and include full chemical names
      (Chemical formulae, abbreviations and generic names are UNACCEPTABLE)
Container is compatible with its contents and is properly closed
No radioactive materials are present in the waste container
      (All radioactive waste is handled by Radiation Safety)