School Chemical Disposal Program Application

Oklahoma Department of Environmental Quality

School Chemical Disposal Program Application

Date of Application:
Contact
Name of Contact Person: / Title:
Best Contact Number: / Email Address:
Will you be at the school on the day of the disposal? (Yes/No):
If “No”, please include the contact information for the person who will be onsite on the day of the disposal:
Contact Person: / Title:
Best Contact Number: / Email Address:
School Identification
School Name:
Street: / City:
Municipality: / County:
State: / Zip Code:
Phone: / Lat/Long:
Fax:
***Please attach map or specific directions if school is difficult to find using street address***
Mailing Address(if different from School Address)
Name:
Street:
City: / State:
Zip Code: / Phone:
Attention:
School District Details
District:
Phone:
Mailing Address:
City: / State:
Zip Code:
County:
Emergency Contacts
Name:
Title:
Phone: / 24-hour Phone:
Name:
Title:
Phone: / 24-hour Phone:

Does your school have a Chemical Hygiene Plan in place*? YESNO

If “yes,” please attach the hygiene plan.

Does your school laboratory have a Chemical Inventory*?YESNO

If “yes,” please convert inventory into our format. A template for DEQ’s chemical inventory

format is located on our website.

Does your school have an appointed Chemical Hygiene Officer*?YESNO

Name of CHO:Phone:

Email Address:

*Please note that the above items are not required in order to qualify for a disposal.

Is your school a public school? (At this time, our YESNO

program is only available to public schools).

I understand that if my school falls into a “Large Quantity Generator” YESNO

categoryfor hazardous waste disposal, additional disposal paperwork

may be required. (You will be contacted if your school falls into this category.)

Examples of the above materials along with other resources for schools can be found at:

and

The DEQ’s Pollution Prevention Program will work with each school to help with future management of laboratory chemicals. After your school has received the one-time disposal, please contact:

Dianne Wilkins – .

Schools will receive assistance on a first-come, first-served and high priority basis. If you believe your school qualifies for a high-priority cleanup, please check the box, and explain why in the space below.

□My school requires a more urgent chemical cleanup

Please submit this applicationelectronically on the website or email to the address below.

Questions about the program may be directed to:

Katrina Pollard

(405) 702-5112

OR

Trenton Wilhelm

(405) 702-5108

DEQ Form #252-100Revision Nov 2016