Breadcrumb Home Chemical Waste Pickup Request Weekly Pickup ScheduleWaste Pickup Question Contacts:Tim Weber(link sends e-mail), Environmental Safety Manager, 319-335-4626 You must have JavaScript enabled to use this form. Generator Information Requestors First Name Requestors Last Name Department Pickup Location Room Number Pickup Location Building Requestors Phone Number Requestors E-mail Address Principal Investigator First Name Principal Investigator Last Name Container Information - Enter a count of the number of containers for each waste type It is not necessary to enter a 0 in the field where you don't have that waste type. Only a container count is required. It is unnecessary to name all of your chemicals. Batteries Lead acid batteries must each have a label attached. All other batteries may be put in a sealed box with one label on the box or label individually. Please provide a count of the number of batteries. USED OIL - Total number of containers SOLIDS - Total Container(s) < 100 grams SOLIDS - Total Container(s) 100 - 500 grams SOLIDS - Total Container(s) 500 grams - 1 kilogram SOLIDS - Total Container(s) > 1 kilogram LIQUID - Total Container(s) < 1 gallon LIQUID - Total Container(s) 1 gallon LIQUID - Total Container(s) 5 gallon LIQUID - Total Container(s) 30 gallon LIQUID - Total Container(s) 55 gallon Gas - Total cylinder(s) Replacement Container(s) Needed? Contact EHS (5-4626) for prior approval. Comments and additional descriptions Certification HawkID Check each box below as confirmation of each statement Container is labeled correctly. Container is compatible with waste type. Container is not too full. Container is clean and free of contamination. HawkID (If you do not have a HawkID, add your intials) I hereby declare that the identification/description of waste is accurate and complete, and that I have made a reasonable effort to minimize this waste. Signed Date Signed Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Signed Date: Day Day12345678910111213141516171819202122232425262728293031 Signed Date: Year Year20232024202520262027 Leave this field blank