The Office of Risk ManagementThe George Washington University
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    On-Line Chemical Removal Request Form

    Please complete the following form to schedule a pick-up of chemical waste. For emergency pickups, please contact the Office of Risk Management at 202-994-3265.

    Generator:   Department:
    Contact Person: Phone:
    Building: Room Number:
    Date of Request: E-Mail Address:

    If you only need to request containers or labels, click here.

    CHEMICAL NAME
    Do Not Use Abbreviations or Formulas.    		 PERCENTAGE
    of each constituent     		PHYSICAL FORM
    of the Waste:    		 QUANTITY
    g; kg; mL;etc.    		 pH
    of liquids
    0.0 - 14.0

    Order Containers and Labels:

    Please make your request for delivery of chemical waste disposal containers and labels below.

    Hazardous Waste Label
    		 8 Ounce Wide Mouth Containter
    		 16 Ounce Wide Mouth Container
    1 Liter Narrow Mouth Container
    		 1 Gallon Narrow Mouth Container
    		 1 Gallon Wide Mouth Container

    Comments/Notes:

    Declaration: I hereby certify that the above information is accurate to the best of my knowledge and ability to determine that no deliberate or willful omissions of composition or properties exist and that all known or suspected hazards have been disclosed. Improper information constitutes violation of Federal Law which could result in civil or criminal penalities.

    Signature Date


     
    © 2002, The Office of Risk Management
    2025 F Street, NW, Suite 101 | Washington, DC 20052 | Fax: 202-994-0130
     
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