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PURDUE UNIVERSITY BIO-MATERIALS PICKUP & TREATMENT CERTIFICATION
Contact REM at 49-40121 For Removal
Completed, signed certification page(s) must be found attached to or near items for pickup.
Requesting Person's Name: ________________________ REM Use Only
Building/Room: ______________ Date________
Phone: ______________ Time________
Other Contact Person: ________________________
TREATMENT CERTIFICATION
Generator Bldg _______ Room _______ Phone _______ Date ___/___/___
Name of Principal Investigator: ________________________________________________________
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1. Category 1 Bio Waste: (known, assumed or suspected of being
infectious to humans before treatment, includes all items
containing or contaminated with human blood or blood products.)
Describe composition of waste material: _______________________________________________
_______________________________________________________________________________
Number of Bags: _________ Number of Boxes: _________
Treatment method:________________________________________________________________
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2. Category 2, "look-alike" waste: (animal tissue, fluids, cell
cultures, Petri dishes.... NOT fitting category 1 description.)
Describe composition of waste material: _______________________________________________
_______________________________________________________________________________
Number of Bags: _________ Number of Boxes: _________
Treatment Method (None Required):___________________________________________________
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Signed: _______________________________________
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