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Scheduled Waste Disposal Form 1

This document is a chemical waste disposal form used by the Chemical Management Unit (CMU) at UTM Kuala Lumpur. The form requires waste generators to provide details of scheduled wastes including name, type, packaging, and quantity. It also outlines the approval and submission process which involves signatures from the waste generator, disposal officer, and SW officer. Additional pages can be attached to list more scheduled wastes.

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Faqrie Azizi
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41 views

Scheduled Waste Disposal Form 1

This document is a chemical waste disposal form used by the Chemical Management Unit (CMU) at UTM Kuala Lumpur. The form requires waste generators to provide details of scheduled wastes including name, type, packaging, and quantity. It also outlines the approval and submission process which involves signatures from the waste generator, disposal officer, and SW officer. Additional pages can be attached to list more scheduled wastes.

Uploaded by

Faqrie Azizi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UTM.K.09.

16/SW/2019/3
CHEMICAL MANAGMENT UNIT FORM SCHEDULED WASTES
(CMU) DISPOSAL FORM
UTM KUALA LUMPUR
COPY CMU / WASTE GENERATOR
READ FIRST:
1. All information provided in this form must be TRUE upon submission.
2. Please fill up the form in ONE (1) copy for each application.
3. Please provide Safety Data Sheet (SDS) together with this form during submission.
4. Please read and understand Standard Operating Procedure for Scheduled Wastes Disposal carefully before fill up this form.
5. Kindly contact SW Officer at +603-2615 4974 or [email protected] for any inquiry.

1. WASTE GENERATOR’S PARTICULARS Mandatory at (*).


*NAME DATE / /
*MATRIC NUMBER / ID NUMBER
*LABORATORY NAME *LABORATORY ROOM NO.
*FACULTY / DEPARTMENT
*MOBILE PHONE / EXT.
*E-MAIL
*SIGNATURE
I, hereby have known the process of
disposing scheduled waste and
have given the correct information
upon submission. I have ensured to
label and separate the scheduled
wastes as requested by SW Officer.
2. SCHEDULED WASTE’S PARTICULARS Mandatory at (*). Disposal Officer
Please use *attachement* for more scheduled wastes. & Waste SW Officer
Generator
NO. *WASTE NAME AND COMPOSITIONS *TYPE *PACKAGING *QUANTITY WEIGHT (kg) SW CODE

NOTE: TYPE PACKAGING


S – Solid BD – Bunghole Drum CW – Clinical Waste Container
L – Liquid TD – Open Top Drum with Cover and Clamp CB – Corrugated / Carton Box
G – Gas BC – Intermediate Bulk Container FJ – Flexible Intermediate Bulk Container / Jumbo Bags
U – Sludge JC – Jerrican / Carboy / Container / Bottle

3. APPROVAL Office Use Only. 4. SUBMISSION BY APPLICANT (*) 5. ENDORSEMENT BY DISPOSAL OFFICER (*)
SW OFFICER REMARKS: I, hereby have delivered the scheduled waste I, hereby have received the scheduled waste by the
___________________________________________________________ safely with the presence of the Disposal Officer. waste generator, then weighted and stored in a safe
___________________________________________________________ manner.
___________________________________________________________
Date of delivery: ___________________ Date of receiving: _________________
___________________________________________________________

________________________________ ________________________________
Name: Name:
________________________________ Stamp:
Name:
Date:
Stamp:

THIS FORM SHALL BE PRINTED ON BLUE PAPER


UTM.K.09.16/SW/2019/3
CHEMICAL MANAGMENT UNIT FORM SCHEDULED WASTES
(CMU) DISPOSAL FORM
UTM KUALA LUMPUR
COPY CMU / WASTE GENERATOR

ATTACHMENT

2. SCHEDULED WASTE’S PARTICULARS Mandatory at (*). Disposal Officer


& Waste SW Officer
Generator
NO. *WASTE NAME AND COMPOSITIONS *TYPE *PACKAGING *QUANTITY WEIGHT (kg) SW CODE

NOTE: TYPE PACKAGING


S – Solid BD – Bunghole Drum CW – Clinical Waste Container
L – Liquid TD – Open Top Drum with Cover and Clamp CB – Corrugated / Carton Box
G – Gas BC – Intermediate Bulk Container FJ – Flexible Intermediate Bulk Container / Jumbo Bags
U – Sludge JC – Jerrican / Carboy / Container / Bottle

3. APPROVAL Office Use Only. 4. SUBMISSION BY APPLICANT (*) 5. ENDORSEMENT BY DISPOSAL OFFICER (*)
SW OFFICER REMARKS: I, hereby have delivered the scheduled waste I, hereby have received the scheduled waste by the
___________________________________________________________ safely with the presence of the Disposal Officer. waste generator, then weighted and stored in a safe
___________________________________________________________ manner.
___________________________________________________________
Date of delivery: ___________________ Date of receiving: _________________
___________________________________________________________

________________________________ ________________________________
Name: Name:
________________________________ Stamp:
Name:
Date:
Stamp:

THIS FORM SHALL BE PRINTED ON BLUE PAPER

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