HazWaste Central Registration Form

HazWaste Central Registration Form

Note: HazWaste Central is open on Saturdays ONLY from 9:00 AM to 12:00 PM.

Online registration is recommended for participation in HazWaste Central. Please be sure to click "submit" at the end of this form. You do not need to bring a copy of the completed form to the collection. There are staff members at collection events to assist with registration.

Cars are received in the order of arrival - no appointments.

Personal Information

First Name*

Last Name*

Address*

City/Town*

Select

Zip*

Email*

Phone

License Plate Number

Type Of Residence*

Select

Date You Will Be Attending HazWaste Central*

Select

Amount of Waste Being Disposed of Today

Amount of Liquid Waste*

0 gallons (0)

Amount of Solid Waste*

0 pounds (0)

Types of Waste Being Disposed of Today

Aerosol (With Waste in Can)

Fluorescent Bulbs

Pool Chemicals

Paints & Paint-related Products

Cleaners (Household/Industrial)

Gasoline

Mercury (Thermometers)

Pesticides/Herbicides

Other (Please specify)

If you are disposing of batteries, please specify what type:

Alkaline

Button-Cell

Lithium

Ni-Cad

Non-Rechargeable

Rechargeable

Other

Different types of batteries should not be mixed. Each type should be in a separate bag or box.

Waste Oil, Antifreeze and Auto Batteries

Please specify amounts in gallons

Antifreeze Mixed with Other Chemicals

Select

Antifreeze Not Mixed with Other Chemicals

Select

Oil Mixed with Other Chemicals

Select

Oil Not Mixed with Other Chemicals

Select

Auto Batteries

Check Box if Disposing of Auto Batteries

We Want to Hear From You

Have you been to HazWaste Central before?

Check Box if Yes

Tell us how you heard about us or provide other comments here.

Are you interested in the “PipeSafe to the Rescue” Program?

The RWA's PipeSafe Protection Program provides low-cost coverage for emergency repairs of your in-home plumbing.

Yes

Send me a copy of my responses

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