Chemical Waste Pickup Request - Part 1 of 2

This request is for the pickup of Chemical Materials only.

To request pickup of Biohazardous Waste or Radioactive Waste, please click on the appropriate link to submit that request.

- Required fields in yellow





¹ Fund

Cost Center

(or WBS Element)

Dept Business Officer

Name of person generating the materials


¹ We cannot accept Federal Grant funds

(211-219) per UAMS Admin Policy 8.3.17

Please do not remove materials from area where they were generated. Be sure that each item is packaged and labeled clearly. If you do not know the chemical composition of an item you must identify it at least qualitatively.

It is against State and Federal Law for Occupational Health and Safety to accept unknowns into the Hazardous Materials/Waste Management Program. By law, it is the responsibility of the generator to identify materials they generate. Please contact Occupational Health and Safety for any needed help in this regard.

Authorizing First Name

Authorizing Last Name

SAP # or

Badge ID #

Work Phone

Email Address

How to resolve your Email

The Badge ID # is located beneath the barcode on your UAMS Student or Employee ID Badge.
Your SAP ID # or Student ID # is found in the upper right hand corner of your UAMS ID.

Your First Name and Last Name must match the name listed for you in SAP.

By clicking on the Submit Part 1 button, you certify you are the authorizing person named above.

Errors Found! Please correct errors indicated in RED and resubmit.