Instructions:
1.	List each item separately by size.
2.	Complete all sections to the best of your knowledge, including contaminants.
3.	Waste will be picked up by EHSO on scheduled days for your building. Click Here for schedule.
NOTE:	Emergency and special waste pickup requests (e.g. lab decommissioning) can be scheduled. Email chemwaste@emory.edu with complete details.
NOTE:	If your P.I., Department, Building is not found in the drop-down box, please email us at chemwaste@emory.edu
	For additional information, please call 727-5922 or view our website: www.ehso.emory.edu

* Investigator


* Department


* Building:

* Room #:	* Contact Name:
* Email Address	* Phone #:

Comments:

Waste Collection Request

Check Here if No Pickups are Required

No	# of Containers	Size	Units	Contents
Ex			Gallons

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Replacement Container Request

Quantity	Type of Container
	5 gallon liquid 2.5 gallon liquid 1 gallon liquid 1 liter liquid 1 liter glass liquid 5 gallon solid 2.5 gallon solid 0.6 gallon solid

Add row Delete row

By submitting this request, I hereby declare that I have personally examined and am familiar with the information submitted in this document. I believe that this information is true, accurate, and complete to the best of my knowledge and that all known and suspected hazards have been disclosed.

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