Waste Disposal Request Form

Please contact cmc@ysu.edu with any further questions regarding your waste.

Department Requesting Waste Disposal *

Location of Waste (Building & room number) *

Responsible Faculty Name *

Your Email Address *

Your Name *

First Name

Last Name

Number of Containers and container size/type (e.g., "three 1L glass bottles", "2x1 gal. plastic jugs") *

ALL containers must have lids. Liquids may NOT be stored in open-head/"open-top" drums or pails/buckets.

Do all waste containers have a completed label? *

Yes

ALL waste containers MUST have a COMPLETED label PRIOR to removal from the lab. Visit ysu.edu/ehs/cmc/waste/hazardous/guidelines for labeling instructions & to obtain waste container labels.

Container may NOT be picked up or removed from the lab until properly labeled

Brief Description of Your Waste (Waste name/type, or process/activity, project/experiment) *

Provide a brief description of the waste generated: e.g., "Used cutting fluid & water", "Halogenated spent organic solvent waste", "corrosive inorganic acid solutions", etc.

Chemical Component Names & Quantities (specify each component name & estimated amount in % wt. or vol.) *

Approx. % Vol. or Qty, with units (in mass/vol.), of each chemical component in the waste. e.g., "Silver Stain Waste": methanol (<=20%), Phosphoric acid (<=5%), glacial acetic acid (<=5%), silver nitrate (<1%), water (balance, >=70%)

Any additional notes or necessary information for CMC staff:

Optional: Photos, Safety Data Sheets, or any additional relevant documentation

ex: detailed inventory list, photos of waste, product SDS, documentation or operating procedures
Files must be less than 2 MB.
Allowed file types: jpg jpeg png tif pdf doc docx ppt pptx xls xlsx.

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