UC Irvine Mercury Containing Lamps / Light Bulbs Recycling Collection Request

Pickup Request Information:
*Required fields
*Name: (first) (last)
*Phone:

 

*Principal Investigator or Supervisor: (first) (last)
*Department:
*Building (Pick up location for unit):
*Room (Pick up location for unit):
*KFS Account:

Item Information:

Number of Lamps / Light Bulbs:

Additional Information: