Name:

Date:

Phone:

Room/Lab#:

Building (Med, Dent, BS, McD, AH, HH, STCBM TDI, Other):
 
Check one:
Exchange
Pickup
Deliver

Do you need pickup tags? (Note: Tags are now required for waste pickup.)
Yes
No

Scintillation Vials: 10-gallon trash can with bag liner

Scintillation Vials: Ziplock bags

Liquid - Small 1-gallon jug:

Liquid - 5-gallon jug:

Solid - 10-gallon trash can with bag liner:

 
Comments: