Syracuse University
Environmental Health Office

Chemical 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 item 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 on 19 July 2007