DEPARTMENT: UNIVERSITY OF OKLAHOMA PRINCIPAL CAMPUS ENVIRONMENTAL HEALTH AND SAFETY OFFICE INVESTIGATOR: ADDRESS: PHONE # HAZARDOUS MATERIALS PICK-UP REQUEST FORM INVENTORY OUHSC (FAX 271-1606) (Office 271-3000) SUPERVISOR: PHONE # OU Norman (FAX 325-7172) (Office 325-2212) EHSO Use Only DESCRIPTION OF CONTENTS SOLID/ 1. Chemical or common name and CAS# of all substances over 1% by Waste Barrel Lab Pack/DOT LIQUID/ PURE/ PRIMARY volume Date Number Hazard Code ROOM DEPT CONTAINER GAS MIXTURE HAZARD 2. Strength (concentration) of individual substance, where applicable. NUMBER CODE* NUMBER AMOUNT (S/L/G) (P/M) CODE 3. Percentages of mixed chemicals in container (by volume) Example : 301 ES 1 4 liters L M F 20% Toluene 108-88-3 80% Xylene 1330-20-7 Hazard Codes: C-Corrosive E-Explosive F-Flammable HT/C-Highly Toxic/Carcinogenic This is to certify that the above named materials are properly I-Irritant O-Oxidizer R-Reactive classified, described, packaged, marked and labeled and are in proper condition for the transportation according to the applicable *See reverse for Department Code listing requirements of the University of Oklahoma Environmental UPON COMPLETION, PLEASE: Health and Safety Office. FAX TO: EMAIL TO: OUHSC, 271-1606 OUHSC,
[email protected] Signature of Authorized Department Representative EHSO USE OU-NORMAN, 325-7172 OU-NORMAN,
[email protected] Pick Up Number: ______________________________ Waste Generated (in lbs.)=_______________________ DEPARTMENTAL CODES-Health Sciences Center Campus (SCC) Peggy & Charles Stephenson (AHB) Allied Health Building (SU) David L. Boren Student Union (OAC) Oklahoma Allergy Clinic Cancer Ctr (BSEB) Basic Sciences Education Building (DMEI) Dean A.