Hazardous Waste Evaluation Legal Business Name(s) * DBA (Doing Business As) name if different from legal business name(s) * License Number(s) * Generator ID(s) * Signee Name * First Name Last Name Title * Email * Phone * Facility Address 1 * Address 1 Address 2 City State/Province Zip/Postal Code Country Pickup Frequency * Date of 1st Pickup(s) * Hazardous Waste Type(s) * Waste Volume * Receptacle Type(s) * Receptacle Quantity * Is there adequate parking lot space at your facility(s) for a box truck to turn around? * Yes No Does your facility(s) have a working loading dock that is accessible? * Yes No Method of recurring payment * Check ACH Transfer Accounts Receivable * All invoices will be directed to the following contact: First Name Last Name Title * Email * Phone * (###) ### #### Thank you!
