Conigliaro Industries, Can It Be Recycled Program Evaluation Form

Mail this form to:
701 Waverly Street
Framingham, Mass 01702

Can It Be Recycled?
Material Evaluation Form

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.

Your Name:

Title:

Company:

Address:

City, State, Zip Code

Telephone:

Fax:

Email:

Waste Material Information

Material 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
Per week Per month Per year

Regulatory Information

Is 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?

Other Information

Send a completed form for each material sample, along with a 5-pound or 5-gallon sample to:
Conigliaro Industries, Inc.
Attn: Materials Laboratory
701 Waverly Street
Framingham, MA 01702