Broken Glass Box Pickup Request

Broken Glass Box Pickup Request
Compliance Notice:

Broken glass containers will not be picked up unless they are taped securely closed and clearly labeled as “Trash.” Please ensure all containers meet these requirements before submitting your pickup request.
Supervisor or Principal Investigator (PI) Name

First NameLast Name
Submitter's Name

First NameLast Name
E-mail
example@example.com
Building
Please Specify
Room Number
Is the box securely taped closed?
Is the box clearly labeled Trash?
Please enter details of the broken glass box location
Picture (if any)

Cancelof
Should be Empty: