Hazardous Material Transfer Form

UNCW Environmental Health & Safety Department
(910) 962-7017

Principal Investigator:


Telephone:       

Building:                         

Room:

What type of container is the chemical waste in ?
Glass  Metal  Plastic Other

What size is the container?

Is the chemical waste virgin product   used product

Physical state of chemical waste:
solid   liquid   solid/liquid   gas

Chemical composition of hazardous material
(100% must be accounted for):
*no abbreviations or formulas please

Name
E-mail
Tel
Fax

Please contact me as soon as possible regarding an environmental & safety matter.