Request for Quote

Request for Quote

Company:
Address:
City, State & Zip:
Country:
Billing address (if different):
Billing City, State & Zip:
Billing Country:
Contact Name:
Phone:
Fax:
Email:
Name of Waste:
US EPA Gen#:
Process generating waste:
Is this a US EPA Hazardous Waste (40 CFR 261)?	Yes No
Please Provide Applicable Hazardous Waste Codes:

Waste Description:

Type of Waste:

pH:

Reactivity
Explosive
Shock Sensitive
Radioactive
Etiological
N/A

Layers
Multi-Layered
Bi-Layered
Single Phased

Physical State at 70°F
Solid
Semi-Solid
Liquid
Powder

Chemical Composition (Total Must Be 100%)
%
%
%
%
%
%

Other Components-Total (PPM)

Shipping Information

Method of Shipment:	Bulk Liquid Drum (type/size):
Anticipated Volume:	Gallons Drums
Per:	One Time Week Month Quarter Year
Is this a DOT hazardous material?	Yes No
If YES, Hazard Class:
Proper DOT shipping name:

Comments:

Fluid Man from IFS Waste Services LLC

Waste Away... Today!

3611 Enterprise Drive • Sheboygan WI 53083-2663 • Phone 920-783-6600 • Fax 920-783-6602