See the PDF version of S70.40.5 for completed example of a Chemical Collection Request. All information entered on the paper form is the same as that entered on the online form. Detailed instructions for filling out the CCR are provided on the back of the paper form. Type or print all information requested on the form. When filling out the CCR, write information in the unshaded areas only .
Name Enter the name of the responsible person who can answer questions about the waste.
In the Mailstop or Gen ID field, enter the department mailcode. Check with the department office to obtain this number. Phone Enter the number at which the responsible person can be reached. Building and Room Specify the building name and room number where the waste is to be collected. Do not use chemical formulae or abbreviations.