Mail this form to:
Can It Be Recycled?
Submit this form along with a 5-pound or 5-gallon sample. Please complete a separate form for each material you wish to have evaluated.
City, State, Zip Code
Waste Material InformationMaterial Name
Known Material Content
Material’s Purpose: Please attach MSDS sheets and other material analysis reports, if available.
Disposal Method Currently Used:
Material Volumes and Weights
Volume of Material: __________ cubic yards
Per week Per month Per year
Weight of Material: __________ tons
Regulatory InformationIs the material regulated by any local, state, or federal authority?
If so, please explain:
Is the disposal of this material regulated by any local, state, or federal authority?
If so, please explain.
Where and how is the material disposed of currently?
Send a completed form for each material sample, along with a 5-pound or 5-gallon sample to:
Conigliaro Industries, Inc.