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Waste Disposal Chemical Pickup Form

  1. Please fill out form completely - incomplete forms will result in pickup delays.
  2. Room must be the location of the waste.
  3. Container Labels from DEHS must be affixed to containers - use the number from the Container Label for the "Container Label# " field below. Contact DEHS at 852-6670 for Container Labels if you do not not have any. Each item must have a container label.
  4. Chemical Name must be the actual chemical name. Formulas, tradenames, and abbreviations cannot be used. If it is a mixture, please separate chemical names with a "/".
  5. Give quantity and units (e.g. 5 gallons). Volume of each container.
  6. Enter up to 15 items. If additional items are to be picked up, please complete another form.
  7. You must use your full email address in the "Email Address..." field below. If you do not receive a copy of this form in your email then it was not submitted correctly.

Thank you for using our online form, and as always, call 852-6670 with any questions.

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**You should receive an automated reply from the Hazardous Waste Coordinator's computer. If you do not receive the reply, please call 852-2956**


last modified 2007-07-26 13:32
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