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► View source for this itemSubjects » Brakes » Environmental and Hazardous Materials

Hazardous Waste

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► Document Sourcehttp://www.fiu.edu/~ehs/forms/Hazardous%20Waste.pdf

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Get StartedREQUEST 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 singleform for multiple containers with the same chemical constituents.* Generators are strongly encouraged to take responsible steps to limit the amount of waste generated and toparticipate in the FIU Interdepartmental Chemical Exchange Program (ICEP) Waste generating department: Request Date: Generator requesting the pick-up: _____ (PantherID)______________________ Title:___________________Supervisor/PI Name:_______________________ Bldg. & Room No: Extension: E-mail: _______________Process generating waste (please be specific): ____________________________________________________________________________________________________________________________________________ Total Est.Volume/Weight of Waste: __________ No. ofContainers:* _________________ 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 properlylabeled? □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 Usesuppliers 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 coursesare 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 NoCharacteristics 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/AViscosity: 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 knownand 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. boxshadowdwnI 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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boxshadowdwn I am responsible for compliance with the waste management regulations for my lab or operations. www.fiu.edu/~ehs boxshadowdwn My signature belowacknowledges my understanding of my responsibilities for compliance with hazardous waste management regulations in my lab or work area. Generator'sSignature:___________________________________ 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/~ehsRelated ItemsLoading related materials...

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