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CHEMICAL WASTE PICKUP REQUEST FORM

Waste pickup requests cannot be processed unless all contact information has been submitted. This form is for chemical waste and labels only. Please do not include biological, radioactive, or sharps waste. To contact EHRS during office hours, Monday through Friday, 8 AM to 5 PM call 215–898–4453

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Notes:

* Indicates required field

Quantity Solvents in 5-Gal Carboys
Halogenated
Non-halogenated
Aqueous
Oil
Other :
Chemical Name Number of Containers Weight or Volume of Containers Physical State

Additional Comments:

All containers must be properly labeled with chemical constituents and percent(%) of constituents prior to removal. Please write out the full chemical names instead of formulas, acronyms or abbreviations.

All containers must be non-leaking and properly sealed prior to removal. If you have leaking or non-sealable containers, please note this in the additional comments sections.

Qty.
Order Waste Labels
  Waste labels Waste Label
Order Waste Containers
  Secondary Containment Bins Secondary Containment Bins
  5-Gallon Carboys 5-Gallon Carboys
  1-Gallon Waste Bottle 1-Gallon Waste Bottle
  Regular Cap
(for 1-Gallon Waste Bottle)
Regular Cap
  Vented Cap for Gas Producing Waste Streams
(for 1-Gallon Waste Bottle)
Vented Cap for Gas Producing Waste Streams

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