Gas Cylinder and Alcohol Barrel Pick-Up Request Form

To ensure timely pick-up of your cylinders and barrels, please do the following: 1. Place your cylinders in the designated area of your loading dock. If your building does not have a loading dock, place the cylinders in the designated area of your building. 2. Mark your cylinders "Empty". 3. Place a cap on the cylinder. If the cylinder does not have a cap, we cannot pick it up. 4. Place alcohol barrels on your loading dock and note "Empty" on the barrel. Please complete all information below: (all fields are required for the form to be processed)
Contact Person Name:
Phone number:
E-mail:
Department Name:
Loading Dock Address:
MDS Account Number:
Total number of items to be picked up (cylinders and barrels):

University of Wisconsin-Madison