Workplace Hazardous Waste Disposal Compliance
Employee Information:
Employee Name: | [Your Name] |
Department: | [Department] |
Job Title: | [Job Title] |
Date: | [Month Day, Year] |
Description of Hazardous Waste:
Type of Waste: | Chemical solvent (Acetone) |
Quantity: | 5 gallons |
Physical State: | Liquid |
Chemical Composition: | Acetone (CAS No. 67-64-1) |
Storage Container Type: | Sealed metal drum |
Disposal Method:
Preferred Disposal Method: | Incineration |
Reason for Disposal: | Waste accumulation from expired solvent batches. |
Documentation of SDS: | Attached |
Safety Measures Undertaken:
Personal Protective Equipment Used: | |
Handling Precautions Taken: | |
Training Received: | |
Certification:
I certify that the information provided above is accurate to the best of my knowledge. I understand the importance of proper hazardous waste disposal and have adhered to company policies and procedures in handling and disposing of the mentioned waste.
Employee Signature:

Date: [Month Day, Year]
Supervisor Approval:
I have reviewed the information provided by the employee and confirm compliance with company guidelines for hazardous waste disposal.
Supervisor Name: [Name]

Date: [Month Day, Year]
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