Chemical Waste Disposal Pickup Form
- Please fill out form completely - incomplete forms will result in pickup delays.
- Room must be the location of the waste.
- 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
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.
- 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 "/".
- 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.
- Give quantity (Qty) and units (e.g. 5 gallons, 4 L, 1 lb) of the size of each container item.
- Enter up to 10 items. If additional items are to be picked up, please complete another form.
- 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.