Waste Pickup Request

*** Note: This form is not for laboratory waste located in the Chemistry Building. If you have lab waste in the Chemistry Building please refer to the current Open House Bulletin to determine when you can bring your waste to a regularly scheduled open house. ***

For all other waste removal at IUB, please fill in the following information.

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Contact Information

First Name:

Last Name:

Phone Number:

E-mail:

Today's Date:

 mm/dd/yyyy

Location of Waste

The room must be accessible to UOEHSM and/or Radiation Safety staff during pickup times. If special arrangements must be made for secured areas, please provide information under "special concerns" on the following page.

Building:

If OTHER Please Specify:

Room Number:

Lab group or Principal Investigator:

Department:

If OTHER Please Specify: