header('Content-type: text/html; charset=utf-8'); Chemical Waste Removal Request Form
 Florida Agricultural And Mechanical University

Chemical Waste Removal Request Form

Please use this form to request the removal of properly identified Chemical Waste.

A copy of the Material Safety data Sheet (MSDS) must also be available upon request by EHS for any chemical type used. No “UNKNOWN” waste can be removed without the permission of the Director of EHS. All containers must be closed and/or sealed, properly labeled and ready for transportation. DO NOT include radioactive, infectious or other biomedical wastes on this form. If uncertain of the proper disposal procedure, contact FAMU-EHS at 599-3442
NOTE: After we have received the form it will take 1 to 3 days for the waste to be picked up.

INSTRUCTIONS FOR COMPLETING THE WASTE REMOVAL FORM:


1. All containers must be properly labeled with chemical names and in the case of solutions, percentages of the waste in that container. DO NOT USE abbreviations, chemical formulas or trade names. If using a container that once contained a different material be sure to clearly mark out the old label and re-label the container with the new contents. Containers should also be labeled with the name of the Principal Investigator, the building and room from which the waste was removed and a phone number.


2. All chemical waste must be in a sealed container, to prevent the release of material (gases/vapors/liquids or solids) under normal handling conditions.


3. Fill out the “Chemical Waste Removal Request Form” (enter all information).
a) Chemical Name and Percent: Spell out the proper chemical name for EACH constituent. For solutions and mixtures use a separate line for each constituent and list the percent of each constituent in the mixture or solution.

b) Physical Form: Give the physical form of the mixture (solid, liquid, gas or other). Please explain “OTHER” in the comments section.

c) Quantity: Provide the total quantity of the chemical/mixture/solution. Use appropriate units of measurement (i.e. g for grams, kg for kilograms, ml for milliliters, L for liters, etc)

d) pH: provide the pH of ALL liquids.

e) Hazard Classification: Please indicate to the best of your knowledge the hazard characteristics of the waste(i.e. explosive, flammable, oxidizer, corrosive, poison etc)

4. Please indicate if replacement containers for waste storage are required. If so, how many?


5. Use the comment section for any additional information (e.g. location of waste in room etc)


Chemical Name (Required)
Identify each substance. Do NOT use abbreviations or formulas.
Percentage(Required)
Indicate percentage amount of each constituent. Do NOT use abbreviations or formulas.
Physical Form of Waste
Solid/Liquid/Gas. If any other type, please explain
Quantity
Gal; kg; ml; L etc
pH of Liquids
0.0 - 14.0
Hazard Classification
Explosive; Flammable; Oxidizer; Corrosive; Poison etc

I need replacement containers.
I do not need replacement containers.
I hereby certify that the above information is accurate to the best of my knowledge and ability. I have determined that no willful omissions of composition or properties exist and that all known or suspected hazards have been disclosed or all infectious organisms/agents have been rendered non-viable.



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