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WM - WASTE MANAGEMENT SERVICE PROVIDER <br /> PICK-UP AND REQUIRED DOCUMENTS <br /> The Non-Saleable Hazardous Material Checklist must be filled out and kept in a clear pouch on top <br /> of each hazardous waste tote and on the side of the universal waste box. The UPC, manufacturer, <br /> description, size and quantity field must be filled out for EVERY ITEM PLACED INSIDE THE TOTE. <br /> This form allows Waste Management to properly identify the contents of the tote during pick-up. <br /> Your store will be supplied with 12 copies of this form for your initial setup which can be found in the <br /> Program Binder. Additional copies can be printed from Online Resources. <br /> Online Resources for Stores> Hazardous Waste Management Program> <br /> Documents & Communication> Non-Saleable Hazardous Material Checklist <br /> NON—RALEABLE HAZARDOUS MATERIAL CHECKLIST o++ d <br /> sw�amne--rov�saee a..e-drnsaile—ell, assfaelaessese sawEoeo�c-+Vr <br /> Tne r�ve-s rami trkaaa�o s>d-nal....easae eve.arretrfr sa mrron eyaar.aa-�...ea se <br /> STORE-M �sa_ey <br /> 1NASiE NFONYAYMN <br /> eR�j �� Olrlfitl0� sea mr. <br /> wwF-damns <br /> The Universal Waste Pick-up Request Form attached to the Universal Waste bin and large box and <br /> must be filled out when Universal Waste is ready for pick-up. Your store will be supplied with 12 <br /> copies of this form for your initial setup which can be found in the Program Binder. Additional copies <br /> can be printed from Online Resources. <br /> Online Resources for Stores> Hazardous Waste Management Program> <br /> Documents & Communication> Universal Waste Pick-up Request Form <br /> W. wnnL <br /> UNIVERSAL WASTE PICK—UP REQUEST FORM <br /> Hello,thank you for contacting Waste Management.If you wish to schedule the pickup of your large box of <br /> Unlversal E-Waste IElectronlca)pleaze use chis form.lf your pick up is for your Hazardous Waste <br /> Totes uch as your Flammable,Corrosive,and Toxic please use the Non.Saleable Hazardous Material <br /> Checkllst. <br /> 1.Re.uert Name <br /> 2.Your 3 digit oro digit stores <br /> 3.Store Fax# <br /> 4.Universal E-Waste l Electronlcsl-total oalletsofthelargeboxes <br /> 5.Please provide the DTL emailaddress <br /> 6.Fax this completed form to 855-254-2246 <br /> Lara.Unlversal E-Waste IElectronlcsl-A Bill of Ladling(BOL)will be faxed W the store displaying the <br /> pickup date.Please provide the BOL to the driver on the day of pickup.The average turn-around time to have <br /> the large Universal E-Waste(electronics)picked up Is 5-7 business days.Please call 8)]-56)-1261 with BOL <br /> and or ns.if we are having diffcultyreachimg you by fax,—will forward ac VAN email to your <br /> ITL <br /> Hazardous Waste Totes-The Non-Saleable Hazardous Materials Checklist can be found and completed im <br /> Onllme Resources aC <br /> http://seprereb.cns.rom/hrcra/ning/HazarJovsWasteVragram/NonSellableHazMatCheckllsLpCf <br /> B16LOTSe► Hazardous Waste Management Program <br /> Revised 3/21/16 <br />