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12/10/2014

Hazardous Waste - Ace Recommendation Platform - 1

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Subjects Brakes Environmental and Hazardous Materials

Hazardous Waste
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Total # of pages: 1
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Price: Free

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http://www
.fiu.edu/~
ehs/forms/
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REQUEST for HAZARDOUS WASTE PICK-UP for DISPOSAL Complete one form for each container of waste. All forms must be complete and signed. You may use a single
form for multiple containers with the same chemical constituents.* Generators are strongly encouraged to take responsible steps to limit the amount of waste generated and to
participate in the FIU Interdepartmental Chemical Exchange Program (ICEP) Waste generating department: Request Date: Generator requesting the pick-up: _____ (Panther
ID)______________________ Title:___________________Supervisor/PI Name:_______________________ Bldg. & Room No: Extension: E-mail: _______________
Process generating waste (please be specific): ____________________________________________________
________________________________________________________________________________________ Total Est.Volume/Weight of Waste: __________ No. of
Containers:* _________________ Container Size(s): _______________/______________________/________________/___________________ Type of Container: Metal
Plastic Glass Containers are clean and sealed properly? Yes No Containers (Fifteen gallons or more) can be tipped without spilling? Yes No Are the containers properly
labeled? Yes No Check waste labeling requirement on EH&S website: www.fiu.edu/~ehs Waste contains: Spent Solvents Infectious material Radioactive Contamination
N/A Please check all that apply: Corrosive Flammable Irritant Reactive Toxic Metals: Yes (ppm) N/A If Yes, please specify: Hazardous Waste Material Profile Use
suppliers MSDS to identify individual ingredient in products or mixtures. All boxes and chemical characteristics below must be checked and the form must be signed On-line courses
are available 24/7 at the EH&S website: www.fiu.edu Chemical Constituents: (Print in English, no chemical Symbols) (%) __________________________ ______
_________________________ ______ _________________________ ______ _________________________ ______ _________________________ ______
_________________________ ______ Total (must add up to 100%) 100% Item is eligible for redistribution via the ICEP program:boxshadowdwn Yes boxshadowdwn No
Characteristics at room temperature: Physical State: boxshadowdwn Solid boxshadowdwn Semi-solid boxshadowdwn Liquid boxshadowdwn Gas boxshadowdwn Gel Layers:
boxshadowdwn None boxshadowdwn Multilayer Free Liquids (%): ___________________ boxshadowdwn N/A Precipitated solids (%): _____________ boxshadowdwn N/A
Viscosity: boxshadowdwn Low boxshadowdwn Medium boxshadowdwn High boxshadowdwn N/A pH: boxshadowdwn < 2 boxshadowdwn > 12 boxshadowdwn N/A Odor:
boxshadowdwn None boxshadowdwn Mild boxshadowdwn Strong boxshadowdwn N/A boxshadowdwn I represent that the information provided is accurate regarding the known
and suspected hazards of the waste submitted to EH&S for disposal. If this form is not signed and containers are too full not properly labeled pickup will be delayed. boxshadowdwn
I am aware that as a generator of hazardous waste, I am required to, and I have completed annual training on the proper handling and disposal of hazardous waste. (40 CFR 262)
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Hazardous Waste - Ace Recommendation Platform - 1

boxshadowdwn I am responsible for compliance with the waste management regulations for my lab or operations. www.fiu.edu/~ehs boxshadowdwn My signature below
acknowledges my understanding of my responsibilities for compliance with hazardous waste management regulations in my lab or work area. Generator's
Signature:___________________________________ Date Pick-up Preferred: ______________ EH&S USE: Control #____________ Date picked up: __ Picked up by:
_________ Weight: ______ lbs. 11/08 EHS- F008 White - Environmental Health & Safety Yellow - Generator retains for 3 years Risk Management and Environmental Health &
Safety Services, CSC 162 Phone: (305) 348-2621 Email: ehslabs@fiu.edu Fax: (305) 348-3574 www.fiu.edu/~ehs
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