Chemical Waste Collection Request Chemical Waste Collection Request Step 1. Verify that all chemicals meet the following conditions:Chemical waste cannot be removed if they do not meet the following conditions specified below:Proper tags/labels, available from EHRS, are fully completed and affixed to each container and include the full chemical name(s)-No chemical symbols, abbreviations, acronyms or trade names (unless a SDS is submitted with the request). Mixtures must be listed as a % and add up to 100%.All waste has been identified specifically and completely on the label/tag. No unknowns. Containers are leak-proof, clean and closed with a tight-fitting or screw-type lids (no stoppered bottles use of paraffin/saran wrap, etc.).Chemical information on this form must match the information on the container tag/label. No DEA controlled substances and/or radioactive materials (including decayed isotopes, uranium salts, etc.) are present in the waste stream. All potentially infectious/biological materials must be properly inactivated. You must list all chemicals to be picked up in Step 4 below. Step 2. Contact/Location InformationPrincipal Investigator/Supervisor Name* First Last Department* Building* Where waste is locatedRoom/Lab #* Where waste is locatedLocation of Waste in Room/Lab* Where in the room/lab is the waste being stored (by the door, rear of lab, etc.).Contact Name* First Last Contact Phone*Contact E-mail Address* This e-mail address will receive a copy of the waste request upon submission.Comments/Collection Notes/Location of Waste Within Lab/Room (list chemicals to be picked up in Step 4 below)Step 3. SuppliesRequest Supplies Available from EHRS* Hazardous Waste Tags 5-gallon carboy Secondary container for chemical waste SAA Posting None Number of Hazardous Waste Tags Requested*Please enter a number from 1 to 100.Number of Carboys Requested*Please enter a number from 1 to 10.Number of Secondary Containers Requested*Please enter a number from 1 to 10.(1 per each Satellite Accumulation Area)Step 4. Chemical InformationProvide information about the Chemical to be Collected. Each requested identical waste stream/chemical is a separate entry. You must enter at least one chemical to be picked up. Number of Containers Physical State State Chemical Name Container Size Amount in Container Ignitable Corrosive Toxic Reactive   Edit Delete There are no Chemicals. Add Chemical I certify the chemical(s), content(s), and hazard characteristic(s) noted above have been reviewed, are accurate, and reflect the information noted on the hazardous waste tag.* Yes Environmental Health and Radiation Safety will only use the provided information to appropriately respond to your request. EHRS will not sell your information or use it for marketing purposes. Please contact us at 215-707-2520 or email@example.com with any questions about how your information is used.