{"id":65,"date":"2019-10-09T16:05:56","date_gmt":"2019-10-09T20:05:56","guid":{"rendered":"https:\/\/sites.temple.edu\/ehrsforms\/?page_id=65"},"modified":"2019-10-10T15:01:48","modified_gmt":"2019-10-10T19:01:48","slug":"chemical-waste-collection-request","status":"publish","type":"page","link":"https:\/\/sites.temple.edu\/ehrsforms\/chemical-waste-collection-request\/","title":{"rendered":"Chemical Waste Collection Request"},"content":{"rendered":"<h2>Chemical Waste Collection Request<\/h2>\n<p>&nbsp;<\/p>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_12' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/ehrsforms\/wp-json\/wp\/v2\/pages\/65' data-formid='12' novalidate><input id=\"gpnf_session_hash_12\" type=\"hidden\" name=\"gpnf_session_hash\" value=\"6675d13f72d5\">\n                        <div class='gform-body gform_body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_12_13\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Step 1. Verify that all chemicals meet the following conditions:<\/h2><\/li><li id=\"field_12_6\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Chemical waste cannot be removed if they do not meet the following conditions specified below:<\/li><li id=\"field_12_7\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >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%.<\/li><li id=\"field_12_8\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >All waste has been identified specifically and completely on the label\/tag. <b> No unknowns. <\/b><\/li><li id=\"field_12_9\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Containers are leak-proof, clean and closed with a tight-fitting or screw-type lids (no stoppered bottles use of paraffin\/saran wrap, etc.).<\/li><li id=\"field_12_10\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Chemical information on this form must match the information on the container tag\/label.  <\/li><li id=\"field_12_11\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >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.  <\/li><li id=\"field_12_39\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b> You must list all chemicals to be picked up in Step 4 below. <\/b><\/li><li id=\"field_12_14\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Step 2. Contact\/Location Information<\/h2><\/li><li id=\"field_12_15\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Principal Investigator\/Supervisor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_15'>\n                            \n                            <span id='input_12_15_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_15.3' id='input_12_15_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_15_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_15_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_15.6' id='input_12_15_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_15_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_16\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_16'>Department<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_12_16' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_18\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_18'>Building<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_12_18' type='text' value='' class='medium'  aria-describedby=\"gfield_description_12_18\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_12_18'>Where waste is located<\/div><\/li><li id=\"field_12_19\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_19'>Room\/Lab #<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_12_19' type='text' value='' class='medium'  aria-describedby=\"gfield_description_12_19\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_12_19'>Where waste is located<\/div><\/li><li id=\"field_12_40\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_40'>Location of Waste in Room\/Lab<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_12_40' type='text' value='' class='medium'  aria-describedby=\"gfield_description_12_40\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_12_40'>Where in the room\/lab is the waste being stored (by the door, rear of lab, etc.).<\/div><\/li><li id=\"field_12_20\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_20'>\n                            \n                            <span id='input_12_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_12_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_20_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_12_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_20_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_21\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_21'>Contact Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_12_21' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_38\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_38'>Contact E-mail Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_38' id='input_12_38' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_12_38\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_12_38'>This e-mail address will receive a copy of the waste request upon submission.<\/div><\/li><li id=\"field_12_22\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_22'>Comments\/Collection Notes\/Location of Waste Within Lab\/Room (list chemicals to be picked up in Step 4 below)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_12_22' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Step 3. Supplies<\/h2><\/li><li id=\"field_12_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Request Supplies Available from EHRS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_29'><li class='gchoice gchoice_12_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Hazardous Waste Tags'  id='choice_12_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_29_1' id='label_12_29_1' class='gform-field-label gform-field-label--type-inline'>Hazardous Waste Tags<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='5-gallon carboy'  id='choice_12_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_29_2' id='label_12_29_2' class='gform-field-label gform-field-label--type-inline'>5-gallon carboy<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='Secondary container for chemical waste'  id='choice_12_29_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_29_3' id='label_12_29_3' class='gform-field-label gform-field-label--type-inline'>Secondary container for chemical waste<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='SAA Posting'  id='choice_12_29_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_29_4' id='label_12_29_4' class='gform-field-label gform-field-label--type-inline'>SAA Posting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.5' type='checkbox'  value='None'  id='choice_12_29_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_29_5' id='label_12_29_5' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_32\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_32'>Number of Hazardous Waste Tags Requested<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_32' id='input_12_32' type='number' step='any' min='1' max='100' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_12_32\" \/><div class='gfield_description instruction ' id='gfield_instruction_12_32'>Please enter a number from <strong>1<\/strong> to <strong>100<\/strong>.<\/div><\/div><\/li><li id=\"field_12_33\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_33'>Number of Carboys Requested<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_33' id='input_12_33' type='number' step='any' min='1' max='10' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_12_33\" \/><div class='gfield_description instruction ' id='gfield_instruction_12_33'>Please enter a number from <strong>1<\/strong> to <strong>10<\/strong>.<\/div><\/div><\/li><li id=\"field_12_34\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_34'>Number of Secondary Containers Requested<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_34' id='input_12_34' type='number' step='any' min='1' max='10' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_12_34 gfield_description_12_34\" \/><div class='gfield_description instruction ' id='gfield_instruction_12_34'>Please enter a number from <strong>1<\/strong> to <strong>10<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_12_34'>(1 per each Satellite Accumulation Area)<\/div><\/li><li id=\"field_12_35\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Step 4. Chemical Information<\/h2><div class='gsection_description' id='gfield_description_12_35'>Provide information about the Chemical to be Collected. Each requested identical waste stream\/chemical is a separate entry. <b> You must enter at least one chemical to be picked up. <\/b><\/div><\/li><li id=\"field_12_36\" class=\"gfield gfield--type-form gform-theme__no-reset--children field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_12_36'><\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-2\">\n\t\t\t\t\tNumber of Containers\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-11\">\n\t\t\t\t\tPhysical State\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-12\">\n\t\t\t\t\tState\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-1\">\n\t\t\t\t\tChemical Name\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-4\">\n\t\t\t\t\tContainer Size\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-13\">\n\t\t\t\t\tAmount in Container\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-15\">\n\t\t\t\t\tIgnitable\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-16\">\n\t\t\t\t\tCorrosive\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-17\">\n\t\t\t\t\tToxic\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-18\">\n\t\t\t\t\tReactive\t\t\t\t<\/th>\n\t\t\t\t\t\t<th class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f2.label, attr: { 'data-value': f2.label }\"\n\t\t\t\t\tdata-heading=\"Number of Containers\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f11.label, attr: { 'data-value': f11.label }\"\n\t\t\t\t\tdata-heading=\"Physical State\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f12.label, attr: { 'data-value': f12.label }\"\n\t\t\t\t\tdata-heading=\"State\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Chemical Name\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f4.label, attr: { 'data-value': f4.label }\"\n\t\t\t\t\tdata-heading=\"Container Size\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f13.label, attr: { 'data-value': f13.label }\"\n\t\t\t\t\tdata-heading=\"Amount in Container\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f15.label, attr: { 'data-value': f15.label }\"\n\t\t\t\t\tdata-heading=\"Ignitable\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f16.label, attr: { 'data-value': f16.label }\"\n\t\t\t\t\tdata-heading=\"Corrosive\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f17.label, attr: { 'data-value': f17.label }\"\n\t\t\t\t\tdata-heading=\"Toxic\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f18.label, attr: { 'data-value': f18.label }\"\n\t\t\t\t\tdata-heading=\"Reactive\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button type=\"button\" class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit Chemical {0} where Number of Containers is {1}.'.gformFormat( $index() + 1, f2.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button type=\"button\" class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete Chemical {0} where Number of Containers is {1}.'.gformFormat( $index() + 1, f2.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"11\">\n\t\t\t\tThere are no <span>Chemicals.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"12\"\n\t\t        data-nestedformid=\"13\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd Chemical\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of chemicals reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_36\"\n                id=\"input_12_36\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><\/li><li id=\"field_12_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >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.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_41'>\n\t\t\t<li class='gchoice gchoice_12_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='Yes'  id='choice_12_41_0'    \/>\n\t\t\t\t<label for='choice_12_41_0' id='label_12_41_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_37\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size:10px\">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. 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