Hazardous Waste Pickup Online Form

To submit a request for hazardous waste pickup, please fill out this form completely and click the submit button.

First Name:

Last Name:


Email address:

Phone Number (555-555-5555):


Supervisor Name:

Organization Number:

Fund Number:

Building where the material is located:

Description of the material you want removed. Please include number of containers, size and contents as well as any additional information needed.