Date: 

Type of Waste:

Radioactive:
 
1. Yes
2. No
Chemical:
 
1. Yes
2. No

Quantity(liters-lbs):
 

Type of Container:

1. Labeled
2. Unlabeled

Contact Person:  Dept: 

Phone Number: 

Email Address: 

IMPORTANT Date and Time you will be in your lab for waste pickup:
 

Comments:

When you are finished filling out the form, click on the Submit Query
button to send the form!!

**Keep in mind that it will take Bruce McClue at least three working days to complete
your request.