California Veterinary Medical Association Form

Please fill in each column for RMW (Bio-Hazardous Waste) - Including Disposable Sharps, if applicable.

Service Frequency

# of Containers/Pickup

Container Capacity/Size

Please fill in each column for Pathological Waste, if applicable.

Service Frequency

# of Containers/Pickup

Container Capacity/Size

Please fill in each column for Non-Hazardous Pharmaceutical Waste, if applicable.

Service Frequency

# of Containers/Pickup

Container Capacity/Size

Please fill in each column for Hazardous Pharmaceutical Waste, if applicable.

Service Frequency

# of Containers/Pickup

Container Capacity/Size

Who is your current medical waste hauler?

When does your contract end?

Please fill in your contact information below

First Name

Last Name

Company

Address

City

State/Province

ZIP/Postal Code

Email Address

Phone Number

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