Instructions for Completing the
"Request for Removal of Hazardous Wastes" Form
1. Fill in the name of your department, e.g., Biological Sciences.
2. Write the Campus phone extension where you can be reached.
3. Write the name of the building and the room number where the waste is located, e.g., Holt
165.
4. Write the date you completed and mailed this form to the Office of Environmental Health
and Safety, Zip 019, Attention: Kenny Wahl.
5. Fill in your full name, first and last.
6. Write the name of the waste chemical. You may use the common name or the name that
was originally used by the manufacturer. Do not use abbreviations or chemical formulas. If
the waste is a mixture that was produced in the laboratory (or stockroom), or by the
manufacturer, write all known chemicals in the mixture, and the percentages that are
present. After the chemical name, write the letter code in parentheses for the physical
state of the waste. After the code for the physical state, write "(o)" if the waste is an
organic chemical; or "(i)" if the waste is an inorganic chemical, e.g., Glacial Acetic Acid (l)
(o). If you do not know whether the waste is an organic or inorganic chemical, leave this
portion blank, e.g., Glacial Acetic Acid (l).
7. Fill in one of the following codes for the container used to store the waste chemical named
in 6:
g= glass bottle
p= plastic bottle
pb= plastic bag
pd= plastic drum
mc= metal can
md= metal drum
oc= other container. Please explain.
8. Write the amount of the waste chemical in the container or fill in the percentage of
available container space that is filled with the waste material. Example, for three liters of
Glacial Acetic Acid that is contained in a four-liter bottle: 3L. If waste is solid and you know
the weight of the waste, please list in this section.
9. Fill in the accumulation start date that appears on the label.
NOTE: If you have any questions, please call Kenny Wahl, x5126.
Request for Removal of Hazardous Waste 8/16/2007
