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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 Health and Safety at 202-994-4347.

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


Do Not Use Abbreviations or Formulas.
of each constituent
of the Waste:
g; kg; mL;etc.
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


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


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