On-line Special Medical Waste Removal Request Form

Generator:
Department:
Contact Person:
Phone:
Email:
Location of Waste (Room/Bldg.)
Department of Safety Officer:
Special Medical Waste type to be removed from laboratory:
Type
Number of containers to be removed:
Other: *Detail "Other" in Comments Section

Comments:

Replacement burn boxes requested: Box(es)

Date Submitted:

   

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Date Modified: April 19, 2006