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CHEMICAL SAFETY PICK-UP FORM CCT Name Department Building Room Phone # Supervisor Container Type Plastic Metal Paper Glass Used or Unused Used Unused Solid/Liquid/Gas Liquid Solid Gas Container Size (ml) Radioactive No Yes Date Chemicals / Percent (must equal 100%) 1) Chemical/Percent 2) Chemical/Percent 3) Chemical/Percent 4) Chemical/Percent 5) Chemical/Percent 6) Chemical/Percent 7) Chemical/Percent Comments Please let us know if there are any problems or suggestions tcarritt@unmc.edu
CCT Name
Department Building Room
Phone # Supervisor
Container Type Plastic Metal Paper Glass Used or Unused Used Unused Solid/Liquid/Gas Liquid Solid Gas
Container Size (ml) Radioactive No Yes Date
Chemicals / Percent (must equal 100%)
1) Chemical/Percent
2) Chemical/Percent
3) Chemical/Percent
4) Chemical/Percent
5) Chemical/Percent
6) Chemical/Percent
7) Chemical/Percent
Comments
Please let us know if there are any problems or suggestions tcarritt@unmc.edu