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Hazardous Waste Pickup Request

(*) Required Fields

Date of Accumulation Start:
Date Container Filled:
Date you wish the waste taken:
If waste container is leaking or damaged to call 284-5112 or 278-7422 immediately for prompt pickup
Contact Person: (*)
Contact Email: (*)
Phone Number: (*)
Location the waste is being stored
Building/Structure Name (*)
Room Number or Description of location (*)
Approximate amount of waste to be collected: (*)
Generator fund source: (*)
Comments:
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