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■ 4C6149P Stericyclex-- Work Order# Reviewed by: Date: Approval#: Picric Acid (Trinitrophenol) Evaluation Form Generator Name: Generator Code: Generator Address: Contact Name: Generator Phone: Contact Phone: Important! Upon discovering an item requiring evaluation,do not remove it from the storage location. Only handle the container if necessary to gain access to the labeling information. You should make every attempt not to handle the container(s). If you need to handle the container to gain information,do so with extreme care. Virgin/Sealed Material? or Spent? has the container ever been opened?(confirm with customer) Yes No If Yes,enter the date opened: Is the material Dry? Or in Solution? List All constituent(s)and their percentages: 1. Picric Acid % 2. % 3. % 4. % 5. % 6. % Picric acid may not be mixed with metals,metal salts,speedi-dri,vermiculite,ammoni,lime,basic/caustic materials,concrete or plaster. Reference manufacturers MSDS for complete list of incompatibilities. Is there any evidence of crystalliztion,cloudiness,wisp-like structures,discoloration,solid mass or any other indication of contamination? Yes No If yes,describe: If in a clear container,what is the color of the material? Has the container been under pressure,bulging,ect.?(confirm with customer) Yes No Container Information Is the product in the original manufacturer's container? Yes No Manufacturer: Purchase Date: Lot Number: Expiration Date: Container size: Volume/Weight remaining in container: Container Type: Glass Plastic Metal Other Cap Type: Glass Plastic Metal Other Cork Condition of Container: Rusted Bulging Dented Other Storage Conditions(confirm with customer) Was the material... Stored on metal,comcrete or plastic? Yes No Unknown Spilled on metal,comcrete or plastic? Yes No Unknown Spilled and placed back in container? Yes No Unknown In contact with vermiculite? Yes No Unknown In contact with Speedy-dri? Yes No Unknown In contact with a spatula or scoop which Yes No Unknown may have been containated?