Hazardous Materials Technical Services Regular Collection Request User Identification Name of principal investigator (PI): * Faculty: * - Select -Faculty of ArtsFaculty of EducationFaculty of EngineeringFaculty of Health SciencesFaculty of MedicineFaculty of ScienceFaculty of Social SciencesFacilitiesOther Campus * - Select -Main CampusAdvanced Research Complex (ARC)Lees CampusAlta Vista Campus (Smyth) Building name: * Room number (If this is an open concept lab, please include work station identifier): * Contact person for collection: * Contact phone number: * Contact person email: * Hazardous Material Pick-Up Details 1 Detailed description of hazardous waste: * Container type/size: * - Select -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: * Total volume of waste (numerical only): * Unit of measure: * - Select -LKg Bring replacement? * Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Hazardous Material Pick-Up Details 2 Detailed description of hazardous waste: Container type/size: - None -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: Total volume of waste (numerical only): Unit of measure: - None -LKg Bring replacement? Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Hazardous Material Pick-Up Details 3 Detailed description of hazardous waste: Container type/size: - None -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: Total volume of waste (numerical only): Unit of measure: - None -LKg Bring replacement? Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Hazardous Material Pick-Up Details 4 Detailed description of hazardous waste: Container type/size: - None -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: Total volume of waste (numerical only): Unit of measure: - None -LKg Bring replacement? Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Hazardous Material Pick-Up Details 5 Detailed description of hazardous waste: Container type/size: - None -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: Total volume of waste (numerical only): Unit of measure: - None -LKg Bring replacement? Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Hazardous Material Pick-Up Details 6 Detailed description of hazardous waste: Container type/size: - None -20 L Black Pail for solid waste20 L white carboy for liquid waste10 L white carboy for liquid waste4.5 L WHITE chemical sharps container5 L white pail for solid waste4 L Amber or Plastic bottleOriginal Bottle205 L Liquid waste drum205 L Solid waste drum23 L YELLOW Bio Pail4.5 L YELLOW bio sharps containerCardboard box with double liner for BIO wasteOther Number of Containers: Total volume of waste (numerical only): Unit of measure: - None -LKg Bring replacement? Yes No Cautionary statement (if applicable): Note: Each waste stream must be listed as a separate item Supply and Equipment Order 1 Item - None -4.5 L. Benchtop white non-biohazardous sharp container4.5 L Yellow benchtop sharps container (Bio only)10 L. White plastic pail with double liner20 L. Black re-useable plastic pail with double liner20 L. Carboy liquid waste container23 L Yellow pail (Bio only)205 L. Liquid waste drum205 L. Solid waste drum with linerAbsorbent pad (each)Vermiculite (20 L. pail)Hazardous waste labelOther (see additional information section) Quantity: Supply and Equipment Order 2 Item - None -4.5 L. Benchtop white non-biohazardous sharp container4.5 L Yellow benchtop sharps container (Bio only)10 L. White plastic pail with double liner20 L. Black re-useable plastic pail with double liner20 L. Carboy liquid waste container23 L Yellow pail (Bio only)205 L. Liquid waste drum205 L. Solid waste drum with linerAbsorbent pad (each)Vermiculite (20 L. pail)Hazardous waste labelOther (see additional information section) Quantity: Supply and Equipment Order 3 Item - None -4.5 L. Benchtop white non-biohazardous sharp container4.5 L Yellow benchtop sharps container (Bio only)10 L. White plastic pail with double liner20 L. Black re-useable plastic pail with double liner20 L. Carboy liquid waste container23 L Yellow pail (Bio only)205 L. Liquid waste drum205 L. Solid waste drum with linerAbsorbent pad (each)Vermiculite (20 L. pail)Hazardous waste labelOther (see additional information section) Quantity: Additional Information: Disclaimer Notice of Collection of Personal Information In accordance with the Freedom of Information and Protection of Privacy Act of Ontario and with University Policy 90, your personal information is collected under the authority of the University of Ottawa Act, 1965. The personal information you provide on this form will be used by the University for purposes consistent with administrating and carrying out University programs, services and activities relating to the planning, review or delivery of programs or services and compliance with policies, procedures and regulations. The information provided in this form will be shared with a third party organization. If you have questions about the collection, use and disclosure of your personal information in this notice, please contact Office of Risk Management at 613-562-5892 or via email at enviro@uottawa.ca Thank you!
