Instructions for Completing:
Request for Hazardous Waste Disposal Form
  1. Name of Chemical(s):  The correct chemical name or names should be typed on the form to identify the material.  Chemical formulas and trade names are not acceptable; i.e. Methylene Chloride, not CH2Cl2.

    For mixtures of liquids, all constituents must be typed on the form, as well as the waste label, and total 100%.  Solutions of solids or gases in liquids, must be expressed in concentrations of either weight percent, molarity (moles per liter), or normality (equivalents/liter).

  2. Number of Containers:  Fill in the number of containers of a specific volume that will be presented for disposal; i.e. if you have 2 X 5 gallon and 10 X 1 gallon containers of the same waste stream, enter "2" under this field, go to the next line and enter "10" in this field (for same waste stream you need not reenter all of the previous information).

  3. Container Volume:  Fill in the container volume(s) that are associated with the entries made in Step #2; i.e. if you have 2 X 5 gallon and 10 X 1 gallon containers of the same waste stream, enter "5 gal." in the field next to the "2" entered in the "No. of Containers" field and "1 gal." in the field next to the "10" entered in the "No. of Containers" field.  REHS will recognize the following volumetric abbreviations:

    Grams - g.     Gallon - gal.
    Pound - lb.     Millileter - ml.
    Liter - L.         Pint - pt.

  4. Other Information:  Use this space to provide any other information that may aid in the safe removal and handling of your waste.

     Sample:

Name of
Chemical(s)
(No Formulas)		 No. of
Containers		 Container
Volume		 Other Information
Ethanol - 95%
Water - 5%		 2 5 gal. Containers located in cabinet
under fume hood.
  10 1 gal.  

 

REHS Homepage