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Chemical Waste Disposal 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.
      Exception: Spent lamps (UV, Mercury, et al) and batteries do not require a DEHS container label for pick up. Users can leave this field blank. However, all other fields must be completed.
    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. Check the appropriate box.  If the chemical waste was generated from being “spent”, or used in a process, check this box.  If the chemical has not been used (i.e. expired, off-spec, no longer need, etc.), check this box.
    6. Give quantity (Qty) and units (e.g. 5 gallons, 4 L, 1 lb) of the size of each container item.
    7. Enter up to 10 items. If additional items are to be picked up, please complete another form.
    8. 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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