Surplus Chemical and "Sharps"
Disposal Request
Print Form
Date
Complete the information as applicable and submit form to EHS.
Contact information
Location
Submitter
Building Name/
Number
Submitter signature
Phone ext. or no.
Room Number
Supervisor
Location in
room
Surplus chemical/waste information
Tag #
Chemical composition
(list all chemical components, including
water and corresponding concentrations)
Sharps
Physical form
Volume or
Container size Container material
Weight
Sharps are to be autoclaved prior to pick-up unless no
suitable autoclave is available in the department and
special arrangements have been made through EHS
Sharps autoclaved?
For EHS Only - Please do not write in the section below
Special instructions/Comments
Rejected
Observations
Container returned
Initials
Date
Charge
Please complete form and submit to Environmental Health and Safety via email, fax 519-824-0364, interdepartmental mail, or in person to Alexander Hall room 162. For more information contact EHS at x53282.