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Chemical Waste Disposal Request Form

Please complete and submit this form to schedule a chemical waste pickup from your laboratory. You will automatically receive an email summarizing your request. EOHSS will notify you of the pickup date. If you have any questions, contact Kyle San Giovanni at (973) 972-4812 or sangiokd@umdnj.edu. If you are having problems submitting the form, you can complete it, print it and fax it to 973-972-3694 or you can access a print version at: http://www2.umdnj.edu/eohssweb/publications/index.htm#Hazardous

Help
* means required field

*Date
*Name   *E-mail
*Campus   *Dept
*Building   *Room #
*Phone   *Fax
Please enter in x-xxxx format   Please enter in x-xxxx format
Please indicate if new or replacement waste containers are needed:  2.5  5  30  55 gallon containers
Please indicate if labels, disposal forms, or signs are needed:  labels  disposal forms  SAA sign  
Additional Information or Comments:
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