Waste Pickup Request Form

Environmental Health and Safety

Please don't fill out this input box.

Department*

First Name*

Last Name*

Email*

Phone*

Building*

Room/Lab Number*

Day/Time Available for Pick-up*

Waste Description (Include a brief description of the waste, such as form, quantity, chemical/physical hazards, etc)*

Is the waste container(s) properly labeled and packaged for pickup?

Yes

Have you completed the Chemical Waste Collection Log / Bio-Waste Collection Form?

Yes

Include a brief description of any needed supplies, such as carboy, biosafety bag, sharps container, etc*