EHS / RMS
3101 Science Circle CPISB 102B
Anchorage, AK 99508
Hazardous Waste Pickup / Disposal Form
This form is to be used for the disposal of all hazardous chemical waste generated by any
teaching or research lab operating at UAA as defined in the UAA CHP and any applicable waste
policy procedures. Check or fill out all blocks that apply to your hazardous waste. ALL
HAZARDOUS WASTE MUST BE PROPERLY LABELED AND IDENTIFIED. E-mail the
completed form to the stockroom manager. Print a copy for your records. Fill out all gray blocks
that appear on mouse over and mark all check boxes as appropriate.
Name:
Date of Request:
1. Disposal Type (check all that apply)
Surplus Chemical
☐
Hazardous Waste
☐
Empty Bottle ☐
NOTE: Some bottles due to contents / residues are considered hazardous waste and are not to
be disposed of as regular trash.
2. a) Categorize the type of hazardous waste that you want picked up. (check all that apply)
Biological (specimens, tissue etc)
☐
Chemical ☐
Other (batteries, compressed gas, metal) ☐
NOTE: Some bottles due to contents / residues are considered hazardous waste and are not to
be disposed of as regular trash.
NOTE: Compressed gases (lecture bottles) require special disposal procedures. Contact EHS at 7861279 or email EHS at uaa_ehsrms@uaa.alaska.edu.
Radioactive Isotope
List Isotope:
☐
Sealed Source ☐
Sealed Planchet ☐
Isotope Activity:
NOTE: All radioactive waste, sealed sources, sealed planchets are handled by the RSO, who
can be reached at 786-1268.
2. b) What are the characteristics of your waste checked in section 2a:
NOTE: For all hazardous chemical waste you must know the characteristics / constituents of
your waste. Unknown waste must be lab tested for verification and tests are
expensive.
Liquid
☐
Volume (L): Click here to enter text.
Semi-Solid (sludge) ☐
Solid
☐
NOTE: Waste containers should be filled between (66 – 80) % and securely capped to allow
for possible expansion.
2. c) What are the characteristics of your waste checked in section 2b:
Corrosive ☐
Flammable / Combustible ☐
Reactive ☐
Inflammable ☐
Toxic ☐
NOTE: Mixed waste is more hazardous and has higher disposal costs, segregate waste
according to characteristics and chemical compatibility.
2. d) For all flammable / combustible or inflammable wastes in section 2c what is the
classification?
Halogenated ☐
Used motor oil ☐
non-Halogenated ☐
Other ☐
NOTE: Mixed waste is more hazardous and has higher disposal costs, segregate waste
according to characteristics and chemical compatibility.
2. e) For all corrosive wastes in section 2c what is the classification?
Mineral Acid ☐
Inorganic Base ☐
Organic Acid ☐
Organic Base ☐
Other ☐
NOTE: Mixed waste is more hazardous and has higher disposal costs, segregate waste
according to characteristics and chemical compatibility.
2. f) For all reactive wastes in section 2c what is the classification?
Grignard Reagent ☐
Butyllithium (etc) ☐
Other ☐
Oxidizer ☐
Peroxide ☐
NOTE: Expired chemicals of these types should be left in their original containers and not
transferred to another container. Contact EHS at 786-1279.
2. g) For all toxic wastes in section 2c what is the classification?
Controlled Substance
☐
Inorganic ☐
Organic ☐
p-Listed ☐
Veterinary ☐
NOTE: Controlled substances require special disposal procedures. Contact EHS at 786-1279
or email EHS at uaa_ehsrms@uaa.alaska.edu.
NOTE: Legend drugs (i.e. prescription drugs) require special disposal procedures. Contact
EHS at 786-1279 or email EHS at uaa_ehsrms@uaa.alaska.edu.
NOTE: P-Listed chemicals require special disposal procedures. Contact EHS at 786-1279
or email EHS at uaa_ehsrms@uaa.alaska.edu.
NOTE: Veterinary drugs require special disposal procedures. Contact EHS at 786-1279
or email EHS at uaa_ehsrms@uaa.alaska.edu.
3. Enter the numbers of containers you have to be removed. Click here to enter text.
4. Please describe in detail all the components that make up your hazardous waste.
NOTE: List percentage, volumes or concentrations for all components to further assist EHS
with the correct disposal of your waste.
5. Where is this waste located?
Building:
Room #:
6. If you have any questions concerning hazardous waste you can call EHS at 786-1279 or
email EHS at uaa_ehsrms@uaa.alaska.edu.
Created by M Riner
Revision 2.7
Date of revision 8/18/2014