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Hazardous Waste Management Program <br />Revised 3/21/16 <br />FRONTSIDE #1 SIDE #2 TOP/LID <br />UNIVERSAL <br />ACCEPTABLE ITEMS:‡¶IRRWÀXRUHVFHQWODPSVRUVPDOOHU <br />• CFL and HID Bulbs <br />• Batteries 0XVWWDSHHDFKHQGWRDYRLG <br /> discharge <br />• Keep larger electronics palletized <br /> which are not eligible for DC return. <br />HANDLE <br />WITH CARE <br />THIS END UP <br />FRONT ONLY <br />UNIVERSAL <br />LARGE UNIVERSAL <br />NO SIGNNO SIGN <br />REMINDER: Vendor or DC returns are notFRQVLGHUHGKD]DUGRXVZDVWHDQGVKRXOGEHNHSW <br />VHSDUDWHIURPWKHXQLYHUVDOZDVWHFROOHFWLRQWRWHELQZKLOHLWZDLWVWREHUHWXUQHG <br />HAZARDOUS WASTE COLLECTION STATION <br />+D]DUGRXV:DVWH&ROOHFWLRQ6WDWLRQ6HWXS <br />9 <br />Waste Type: (please write in large legible letters)Collection Start date: <br />Page# of <br />Collection Pickup date: <br />Store #: <br />Store Address: <br />City,State, Zip Code: <br />Store Phone Number: <br />WASTE INFORMATION <br />STORE INFORMATION <br />Store Manager: <br />Manager Contact Number (cell): <br />Pick-up Hours: <br />Loading Dock Available: <br />Who Will Sign Paperwork: <br />Notes/Comments: <br /> <br />7…i˜…>â>À`œÕÃÜ>ÃÌiVœiV̈œ˜Lˆ˜ˆÃÀi>`Þ̜Li«ˆVŽi`Õ«]i˜ÃÕÀi>wi`Ãœv̅ˆÃ`œVՓi˜Ì>Àiwi`œÕÌVœ“«iÌiÞ>˜`v>Ý̜nxx‡Óx{‡ÓÓ{È°<br />>Ü>ÃÌi“>˜>}i“i˜Ì>Ì£‡nÈȇn£™‡£™ÓÈ̜ÃV…i`ՏiޜÕÀ>VÌÕ>«ˆVŽÕ«° <br />UPC (prefered)(If no UPC you may use article)Manufacturer Example - Clorox DESCRIPTIONExample - Scented Bleach SIZEExample - 64oz QTY. <br />NON-SELLABLE HAZARDOUS MATERIAL CHECKLIST <br />       <br />   <br />5  <br />""%1*$!/%+%(%$** $)* $#$*3 /%+- )*%)+"*& !+&%/%+("(%.% <br />$ ,()"4)*6"*(%$ )7&")+)* )%(#3 /%+(& !+& )%(/%+(0(%+))* <br />%*)1)+)/%+("##"1%((%) ,1$%. &")+)* %$4""0(%+) *( " <br />!" )*3 <br /> <br />;3 '+)*() # <br /> <br /><3 %+(=  *%(>  *)*%(8 <br /> <br />=3 *%(.8 <br /> <br />>3 $ ,()"4)*6"*(%$ )74*%*"&""*)%*"(%.) <br /> <br />?3 ")&(%, * # "()) <br /> <br />@3 .* )%#&"*%(#*%B??4<?>4<<>@ <br /> <br /> ($ ,()"4)*6"*(%$ )75 ""%  $6 7- "".*%*)*%( )&"/ $* <br />& !+&*3")&(%, * *%*( ,(%$*/%& !+&3,(*+($4(%+$* #*%, <br />*"($ ,()"4)*6"*(%$ )7& !+& )?4A+) $))/)3")""BAA4?@A4;<@;- *  <br /> ))+)$%(%$($)3 -(, $  +"*/( $/%+/.1-- ""%(-(%&/, # "*%/%+( <br /> 3 <br />0(%+))*%*)4 %$4""0(%+) *( ")!" )*$%+$$%#&"* $ <br />$" $)%+()*2 <br />   <br />              <br />      <br /> <br />       <br />   <br />5  <br />""%1*$!/%+%(%$** $)* $#$*3 /%+- )*%)+"*& !+&%/%+("(%.% <br />$ ,()"4)*6"*(%$ )7&")+)* )%(#3 /%+(& !+& )%(/%+(0(%+))* <br />%*)1)+)/%+("##"1%((%) ,1$%. &")+)* %$4""0(%+) *( " <br />!" )*3 <br /> <br />;3 '+)*() # <br /> <br /><3 %+(=  *%(>  *)*%(8 <br /> <br />=3 *%(.8 <br /> <br />>3 $ ,()"4)*6"*(%$ )74*%*"&""*)%*"(%.) <br /> <br />?3 ")&(%, * # "()) <br />@3 .* )%#&"*%(#*%B??4<?>4<<>@ <br /> <br /> ($ ,()"4)*6"*(%$ )75 ""%  $6 7- "".*%*)*%( )&"/ $* <br />& !+&*3")&(%, * *%*( ,(%$*/%& !+&3,(*+($4(%+$* #*%, <br />*"($ ,()"4)*6"*(%$ )7& !+& )?4A+) $))/)3")""BAA4?@A4;<@;- *  <br /> ))+)$%(%$($)3 -(, $  +"*/( $/%+/.1-- ""%(-(%&/, # "*%/%+( <br /> 3 <br />0(%+))*%*)4 %$4""0(%+) *( ")!" )*$%+$$%#&"* $ <br />$" $)%+()*2 <br />   <br />              <br />      <br /> <br />       <br />   <br />5  <br />""%1*$!/%+%(%$** $)* $#$*3 /%+- )*%)+"*& !+&%/%+("(%.% <br />$ ,()"4)*6"*(%$ )7&")+)* )%(#3 /%+(& !+& )%(/%+(0(%+))* <br />%*)1)+)/%+("##"1%((%) ,1$%. &")+)* %$4""0(%+) *( " <br />!" )*3 <br /> <br />;3 '+)*() # <br /> <br /><3 %+(=  *%(>  *)*%(8 <br /> <br />=3 *%(.8 <br /> <br />>3 $ ,()"4)*6"*(%$ )74*%*"&""*)%*"(%.) <br /> <br />?3 ")&(%, * # "()) <br /> <br />@3 .* )%#&"*%(#*%B??4 <?>4<<>@ <br /> <br /> ($ ,()"4)*6"*(%$ )75 ""%  $6 7- "".*%*)*%( )&"/ $* <br />& !+&*3")&(%, * *%*( ,(%$*/%& !+&3,(*+($4(%+$* #*%, <br />*"($ ,()"4)*6"*(%$ )7& !+& )?4A+) $))/)3")""BAA4?@A4;<@;- *  <br /> ))+)$%(%$($)3 -(, $  +"*/( $/%+/.1-- ""%(-(%&/, # "*%/%+( <br /> 3 <br />0(%+))*%*)4 %$4""0(%+) *( ")!" )*$%+$$%#&"* $ <br />$" $)%+()*2 <br />   <br />              <br />      <br /> <br />8VHWKH8QLYHUVDO:DVWH3LFNXS <br />Request Form for the Universal <br />Waste tote and box.