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Chemical Collection Request

Name: Mail Stop: Phone: Building: Email: Room:     Location: Pullman Wenatchee Prosser Spokane Puyallup Mount Vernon

Constituent Percentage Complete names ONLY. No formulas, abbreviations Do not use a '%' symbol Constituent: Percentage: %

Physical State: SolidLiquidGas Number of Containers:

Weight/Volume: Select Units: Milligrams Grams Kilograms Milliliters Liter Gallons Pounds

Major Hazard: Flammable Poison Oxidizer Explosive Air/Water Reactive Corrosive

Secondary Hazard(s): Flammable Poison Oxidizer Explosive Air/Water Reactive Corrosive

Additional Information:

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