Request to Test Unknown

This online form should be used to request testing of chemicals destined for disposal when the constituents are unknown. There is a fee of $15 per container associated with the standard testing.
For questions contact Jim Pyrz, 335-4625.

Today's Date

Month

Day

Year

Requestor's Information

First Name *

Last Name *

Requestors Phone Number *

Room Location of Unknown *

Building Location of Unknown *

Requestors E-mail Address *

Department *

Principal Investigator (First & Last Name) *

Container(s) Information

Total Number of Unknown Containers to be Tested *

Container(s) Description (List Type, Size and Chemical Form, Liquid or Solid)

Briefly describe the types of procedures/processes that are performed in the area.

MFK Billing Information

There is a fee of $15 per standard test per container.

Fund (xxx) *

Org (xx) *

Dept (xxxx) *

Subdept (xxxxx) *

Grant/Pro (xxxxxxxx) *

Inst. Acct. (xxxx) *

Org. Dept. (xxx) *

Dept. Acct. (xxxxx) *

Function (xx) *

CCTR (xxxx) *

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Request to Test Unknown