Syracuse University
Environmental Health Office

Medical Waste Pick-Up Request Form

Fill out this form or call 443-9132.

PICKUP REQUEST INFORMATION
This information will help us to provide you with SAFE AND EFFICIENT waste management services.

Name:
Phone #:
E-mail:
Employee Status:
Department:
Principal Investigator / Supervisor (If appropriate): 
 Describe Each Waste Stream below: 
(List of the number and size of each waste container) 

Pick-up building:  Pick-up room: 

 1. material  Quantity / # of Containers 
 2. material  Quantity / # of Containers 
 3. material  Quantity / # of Containers 
 4. material  Quantity / # of Containers 
 5. material  Quantity / # of Containers 
 6. material  Quantity / # of Containers 
 7. material  Quantity / # of Containers 
 8. material  Quantity / # of Containers 
 9. material  Quantity / # of Containers 
10.material  Quantity / # of Containers 


    NOTE: EHO staff must be informed of any special hazards
    associated with waste materials. If you cannot identify
    chemical constituents of waste materials prior to pick-up,
    contact EHO immediately for further instructions. 
Last modified: Wednesday, September 28, 2005