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Chemical Pickup Form:

Container Number:i.e. 1 of 10
Principal Investigator:
Department:
Room:i.e. BE 1.111
Phone:
Waste Type:

LIST ONLY 1 CONTAINER PER FORM
Every container MUST be labeled with percent of EACH chemical, including water.

Amount
(ml or g)
%
(MUST add up to 100)
Chemical Waste Description
(If a mixture, indicate % of each component)

NO FORMULAS PLEASE.



Indicate if you would like a replacement container. Signify how many containers you would like and the contents that are going to be stored in the container


By clicking Submit, I certify that the following information is correct to the best of my knowledge and the chemical(s) are in a proper container for handling and identification.




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Updated: December 31, 1969