Feedback Form

Contact Person:

Business Name:

Address:

City:

State:

ZIP:

Phone:

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Please provide us with the following information:

Are you currently recycling used lamps/ballasts? Yes No

Are you interested in a quote to perform lamp/ballast recycling? Yes No

Number of facilities:

Locations:

Estimated annual volume of used lamps:

Type: Volume:

Estimated annual volume of used ballasts:

Type: Volume:

Current Hazardous Waste Generator Status:

Are you interested in the recycling of other wastes? Yes No

If yes, what types of waste?

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