Hazardous Materials Technical Services Regular Collection Request User Identification Name of principal investigator (PI): * Faculty: * - Select -Faculty of Science - Main CampusFaculty of Science - Advanced Research Complex (ARC)Faculty of Engineering - Main CampusFaculty of Engineering - Advanced Research Complex (ARC)Faculty of MedicineFaculty of Health SciencesFacilitiesOther 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: * Principal investigator email: Engineering Regular Collection Day: Tuesday (1.30 p.m. - 3.30 p.m.) Medicine Regular Collection Day: Wednesday (9 a.m. - 12 p.m.) Friday (9 a.m. - 12 p.m.) Regular Collection Day: Wednesday (2.30 p.m. - 4.30 p.m.) Science Regular Collection Day: Tuesday (9 a.m.-12 p.m.) Thursday (9 a.m.-12 p.m.) Science - ARC Regular Collection Day: Fridays (1.30 p.m.-3.30 p.m.) Hazardous Material Pick-Up Details 1 Description and identification: * Total Quantity L/Kg: * Container type/size: * # of Units: * Bring replacement? * Yes No Hazardous Material Pick-Up Details 2 Description and identification: Total Quantity L/Kg: Container type/size: # of Units: Bring replacement? Yes No Hazardous Material Pick-Up Details 3 Description and identification: Total Quantity L/Kg: Container type/size: # of Units: Bring replacement? Yes No Hazardous Material Pick-Up Details 4 Description and identification: Total Quantity L/Kg: Container type/size: # of Units: Bring replacement? Yes No Hazardous Material Pick-Up Details 5 Description and identification: Total Quantity L/Kg: Container type/size: # of Units: Bring replacement? Yes No Hazardous Material Pick-Up Details 6 Description and identification: Total Quantity L/Kg: Container type/size: # of Units: Bring replacement? Yes No 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!
