Language
English (US)
EH&S Material Pick-Up Request
Florida Gulf Coast University
Request Date:
/
Month
/
Day
Year
Date Picker Icon
For EH&S Use Only
This material is:
*
Usable/ For Redistribution
Used Product for Recycling
Waste for Disposal
Generator:
Department:
*
Principal Investigator:
First Name
Last Name
Contact Person:
*
First Name
Last Name
Contact Phone #:
-
Area Code
Phone Number
Contact Email:
*
example@example.com
Location:
*
Room:
Best Time:
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
How is container labeled?
Size of Container(s):
Include units
Number of Containers:
*
Approx Total Volume:
In gallons
Material Identification
List all constituents and percent of total volume below, including water (also list these on each container)
This should be considered a hazardous waste because it is:
Ignitable,
Reactive,
Toxic,
Corrosive, OR
Listed as a hazardous waste in Title 40 Code of Federal Regulations (CFR) Part 261, Subpart D.
Material Management
For EH&S Use Only
EH&S Signature
Date Signed
*
/
Month
/
Day
Year
Date Picker Icon
Submit
Print Form
Should be Empty: