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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.
General Information
Contact Name
Title
Company
Address
City, State, Zip Code
Telephone
Fax
Waste Material Information
Material Name
Known Material Content
Material’s Purpose
Material Volumes and Weights
Disposal Method Currently Used
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.
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