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

* Name:
* Building:
* Room:
* Work Phone #:
* Email Address:
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 gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select State gal l ml lb kg Select Unit liquid solid liquid/solid mix gas Select 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 Order Waste Containers    Secondary Containment Bins 5-Gallon Carboys 1-Gallon Waste Bottle Regular Cap (for 1-Gallon Waste Bottle) Vented Cap for Gas Producing Waste Streams (for 1-Gallon Waste Bottle)