Request to Test Unknown

Today's Date

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(link sends e-mail), 335-4625.

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)