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2011Veolia-Business-Chemical-Inventory-form

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					TECHNICAL SOLUTIONS
NORTH AMERICA

                                VSQG CHEMICAL INVENTORY

Business/Generator Name:

Mailing/Street Address:

City, State, Zip Code:


Contact Persons:                                               Telephone:


County of Business/Residence:                                          Fax:


Please weigh your materials (in their containers). The quote will be based on the weight provided.

   Waste Name/                   Number of                    Container               TOTAL Volume
   Description                   Containers                      Size                   In pounds
Sample:  Diazinon                    3                         1-gallon                 24 pounds




          Free Technical Assistance is available to complete this form at 1-715-298-2623.
  Attach additional sheet(s) if necessary. Explosives and ordnance, radioactive materials, and infectious
      wastes will not be accepted during this collection event. Please consult Veolia on these items.

              Please fax or email this completed form to Chris Bahlow at (262) 255-5794 or
                                      Chris.Bahlow@VeoliaES.com.

				
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