Electronic and Scrap Metal Disposal Survey Form

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ALFRED UNIVERSITY SURVEY FOR REMOVAL OF USED COMPUTER and
OTHER ELECTRONIC EQUIPMENT or INSTRUMENTS, NON-ALKALINE
BATTERIES and SCRAP METAL
Semester: Spring / Fall
Year:
(Circle one)
Please search out all unwanted used electronic equipment or instruments
that would qualify for recycling based on the Disposal of Used Computer
Equipment and Other Used Electronics Policy. Office equipment, nonalkaline batteries and scrap metal will also be accepted for recycling.
Chairperson, Supervisor or designee should coordinate department survey
efforts to eliminate duplicate submissions. Submit completed form to Dean
Perry no later than 1 day prior to the announced collection date at
[email protected] or Myers Hall, Room 117.
Note: Please attach a label on equipment and/or boxes with the following
information: Division Name and the words “For Electronic Recycling”
Specific Location of stored material for pick-up __________________________
Name/Division _________________________ Building ___________________
Number of units:
Monitors (CRT) ____________ approx. size ___x___x____
Separate Disc Drives _______
Monitors (CRT) ____________ approx. size ____x___x___
Keyboards ______ Mouse (s) _____
Computer processing units _______________ approx. size ____x___x____
Computer processing units _______________ approx. size ____x___x___
PLEASE BOX CABLES, BATTERIES AND SMALL ELECTRONICS.
Other equipment: (scrap metal, batteries, printers, fax machines, TVs,
VCRs, PC Boards, UPSs, cables, laboratory instruments, etc.)
What is it _____________ how many _________ approx. size __x___x__
What is it_ _____________ how many _________ approx. size __x___x__
What is it ______________ how many _________ approx. size __x___x___
What is it______________ how many __________ approx. size __x___x____
Name of person submitting this survey____________ phone #___ ____
Dean Perry
EH&S Technician
Hazardous Waste Coordinator
Office: x3020 [email protected]
Fax: x2086
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