Chemical Waste Pickup Request

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Name* Required

Additional Location Details

Accumulation Started Date

Container Type* Required

Container Contents

Type

Percentage

Department Requesting* Required

Department Cost Code* Required

Physical State of Waste

Primary hazard of waste* Required

pH of Substance

Container Size (#)

Container Unit of Measure

Quantity Remaining

Weight of Remaining Quantity