CHEMICAL WASTE DISPOSAL AUTHORIZATION
(CONTAINER OF MIXED WASTE ONLY)
SUPERVISOR’S NAME
APPLICANT NAME
WORK PHONE
DATE
YYYY
BUILDING
ROOM/LAB
DEPARTMENT
MM
DD
CONTAINER NO.
TYPE OF WASTE MIXTURE
(Please check the appropriate box below.)
ORGANIC SOLVENT (NONHALOGENATED)
ORGANIC SOLVENT
(HALOGENATED)
INORGANIC (AQUEOUS)
INORGANIC (NON-AQUEOUS)
ACIDS
ORGANIC SOLID
BASES/CAUSTIC
INORGANIC SOLID
PHOTO PROCESSING CHEMICALS
DEBRIS CONTAMINATED WITH RESIDUAL TOXIC/HAZARDOUS MATERIALS
PROVIDE VOLUME, WEIGHT AND CONCENTRATION OF EACH CHEMICAL IN MIXTURE1
CHEMICAL NAME
VOLUME
TOTAL
1
WEIGHT
CONCENTRATION
TOTAL
If mixture is liquid – give volume. If mixture is solid – give weight in grams. Total weight/volume to be listed in the last column.
ATTACH 2 COPIES TO WASTE CONTAINER. RETAIN 1 COPY FOR YOUR FILES.
SIGNATURE
DATE
YYYY
MM
DD
This information is collected under the authority of the Freedom of Information and Protection of Privacy Act (FOIP), the Hazardous Products Act, Alberta
Environmental Protection and Enhancement Act, Canadian Environmental Protection Act, Transportation of Dangerous Good Act and Regulations and the
Transportation of Dangerous Goods and Handling Act. It is required to authorize and record the disposal of chemicals. If you have any questions about the
collection or use of this information, please contact Hazardous Materials Services at hazmat@ucalgary.ca.