Hazardous Waste Pick Up Request

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I (the Generator) of the waste materials listed have properly labeled these items and they qualify as hazardous waste according to EPA and Clemson University guidelines as referenced in the University's HAZARDOUS WASTE MANAGEMENT MANUAL. These items have been screened into the hazard type group and properly segregated to ensure safe temporary storage.

  1. Please provide the following Generator information:
    Name
    Title
    Department
    Work Phone
    FAX
    E-mail
  2. The waste materials listed below have been properly labeled and are stored in: (building and room #)


  3. Check ONE only - use a separate form for a different hazard type: Waste Corrosives (includes corrosive poisons); Waste Flammables (includes flammable corrosives and flammable poisons); Waste Reactives (Includes oxidizers, ethers, and peroxides); or Waste Poisons

    Reactive
    Corrosive
    Flammable
    Poison
    Other

  4. Please enter the name of the chemical or mixture (include constituents and percentages of each):.


  5. How much (just type in the number corrsponding to how much you have, e.g. if you have 3 ounces type "3"):


  6. What is the unit of volume (e.g. if you have 3 ounces, select "ounces"):


  7. What type of container is this waste stored in?


  8. What size container (in the same units as the volume, e.g. if you have 3 ounces in a 1 pint bottle put in 16):


  9. Principle Investigator/Supervisor Name [if applicable]


  10. Please enter comments below: