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Waste Pickup Request

To let Environmental Health, Safety and Risk Management know that you are in need of a waste pickup, complete the following and then click on the Submit button.

All fields marked with asterisk (*) are required.

text field
text field
text field
required email address field
text field
text field
text field
textarea field
Include a brief description of the waste, such as form, quantity, chemical hazards present, etc.
radio button field
Supplies Needed?
checkbox field
If you answered yes above, check the appropriate box(es) to indicate the supplies needed.