AirCycler Bulb Eater 3 - Pick-Up Request Form

800.909.9709
www.AirCycle.com [15]
Pick-Up Request Form
Schedule a Pickup online at www.aircycle.com/services or call 800.909.9709
Date:
Company: Company:
Address:
Address:
City/State/Zip: City/State/Zip:
Contact:
Accounts Payable Contact:
Contact E-mail:
Accounts Payable Phone:
Contact Phone: Accounts Payable E-mail:
Contact Fax: EPA ID#:
Alternate Contact/Phone: PO#:
A truck with a lift gate is required to pick up the material. Yes No
Is there a forklift available to load the material onto the truck? Yes No
Quantity
The material will need to be manually loaded onto the truck. Yes No 55 Gallon Steel Drums
Note: manpower charges for loading may apply 4' Fiber Drums
A full size tractor-trailer can fit into the loading dock. Yes No 4' Lamp Boxes
Height and length restrictions for the loading dock are: 8' Lamp Boxes
Where is the material stored within your facility:___________________________________ 5 Gallon Poly Pails
Available Loading Hours: _________________________
Failure to complete this section may delay the scheduling of service to your facility
Material To Be Picked Up:
Lamps: Quantity
55 Gallon Drums of Crushed Lamps
55 Gallon Drums of Crushed CFL's
Quantity
4ft. or Less Fluorescent Lamps
Steel Drums (55 Gallon)
5ft. - 8ft. Fluorescent Lamps Cardboard Boxes
9ft. or More Fluorescent Lamps
4' Fiber Drums (85 count)
U-Bend / Circular 4' Fiber Drums (185 count)
Compact w/o Ballast 8' Fiber Drums (85 count)
HID (Mercury Vapor, Metal Halide, High-pressure Sodium)
Other:
Shattershield / Coated Total of Pallets:
Incandescent
UV
Other Waste for Recycling Pick Up:
Office Machinery (E-scrap):
Other Waste:
Special Instructions:
Mixed
Batteries:
Weight
Failure to complete this section may delay the scheduling of service to your facility.
Replacement Containers:
Transportation Requirements section is required.
Pick-Up Request Form
2200 Ogden Avenue, Suite 100 • Lisle, IL 60532
Generator Pick-Up Location
Generator Billing Information
Tel (800) 909-9709 • Fax (866) 909-6725 • www.aircycle.com
Compact w/Ballast
Weight
The Material Is Packaged In:
Poly Pails (5 Gallon)
Zinc Carbon
Alkaline
Lithium
NiMH
NiCad
Ballasts:
Non-PCB
PCB
Lead Acid
Mercury
The marked material is to be properly identified and prepared for transportation and tender in accordance with all applicable statutes, ordinances, permits, rules and regulations of the Federal, State, and
Local governments in whose jurisdiction such material originates, passes through, or is tendered for delivery (certify for declare) under penalty of perjury that the foregoing is true and correct. Do not
place any extraneous material or liquids in the drum. Presence of these materials with the crushed lamp waste could result in very significant upcharges or potential return of the waste to your facility.
All final counts will take place at the end destination processing facility.
Please fill out this form completely and fax it to 866-909-6725 or e-mail to pickup@aircycle.com
Have you tried our online services? Visit us at AirCycle.com/services to schedule your pickup online today!