Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Pacakging/
Storage
Entered
Picked
Up
5
4
3
2
1
Chemicial Mixture/Composition
Form Recd:
Chemicals Picked Up: Name:
Date:
Rev 04/06
Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Pacakging/
Storage
Entered
Picked
Up
7
6
Chemicial Mixture/Composition
Form Recd:
Chemicals Picked Up: Name:
Date:
Rev 04/06
Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Chemicial Mixture/Composition
Form Recd:
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Chemicals Picked Up: Name:
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Date:
Pacakging/
Storage
Entered
Picked
Up
Rev 04/06
Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Chemicial Mixture/Composition
Form Recd:
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Chemicals Picked Up: Name:
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Date:
Pacakging/
Storage
Entered
Picked
Up
Rev 04/06
Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Chemicial Mixture/Composition
Form Recd:
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Chemicals Picked Up: Name:
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Date:
Pacakging/
Storage
Entered
Picked
Up
Rev 04/06
Hazardous Waste/Surplus Chemical Collection Form
WWU Environmental Health & Safety Office
Label each container. PLace hazardous waste labels on waste containers only. Please complete this form and return it to the
Environmental Health & Safety office, MS9070. Fax 650-6514. Call 650-3064 if you have any questions. Email: [email protected]
Department
Building/Room Number
Telephone
Date
I hereby certify that all materials referenced below are fully accurately described, packaged and labeled according to the procedures of the
Western Washington University Chemical Waste Management Sheet. Information is available at: www.wwu.edu/depts/ehs
Name (Please Print)
Signature
EHS Office Use Only
Chemicial Mixture/Composition
Form Recd:
Number
of
Containers
Type/Size
Amount
of
of Waste
Container in Container
Physical
State
(S/L/G)
Chemicals Picked Up: Name:
Container
Number
HW
Codes
Hazard
Info/Notes
Gross
Weight
Date:
Pacakging/
Storage
Entered
Picked
Up
Rev 04/06