| Location: |
| Building where waste is stored: |
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| Room Number/Area: |
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| Your Information: |
| Your Name: |
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| Your Department: |
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| Your Telephone #: |
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| Email Address: |
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| Principal Investigator/Supervisor: |
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| Waste: |
| Container Size: |
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| Type of Waste (Please indicate if sharps): |
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| Comments: |
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| (Please fill out information individually for each container.) |
| |
| |
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