West Virginia University
Environmental Health and Safety
Hazardous Chemical Disposal Form
College
Building Room  
Generator Last Name: Generator First Name: Generator Middle Initial:
Chemical Hygiene Officer (CHO) Name of Person Completing Form  
Department Phone: Today's Date:

  Hazard Classes                      
  F = Flammable
CA = Carcinogenic
C = Corrosive		 R = Reactive
I = Irritant
T = Toxic		  
Quantity
(1 litre, 5 lbs, etc.)
Chemical
(Approx. % of each)
Manufacturer
Hazard Class
Location
(Specific)
Reusable
(Yes/No)
Environmental Health and Safety is continuing to develop this form to allow for additional chemicals to be input in a single session. If you have any comments regarding this form, please email EH&S at EHS_Chemicals@mail.wvu.edu or contact EHS at 304-293-3792.