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CUSTOMER WASTE DISPOSAL APPLICATION FORM
COMPANY INFORMATION
  Company Name :
Scope of Business :
Address :
Phone :
Fax :
E-mail :
Web address :
Customer No :
Application No :
WASTE DETAILS
Name of the Waste :
Description of waste production process :
Known components of waste :
Physical Specification of the waste : Dust Dusty Pasty Sludge Solid Liquid Gas
Dimensions, if solid :
Weight :
Other Details :
Estimated waste quantity : Existing
RISK CONDITIONS
Fire Risk Destructive of health Special Hazard Special Hazard
 Under 23° Fatal Oksidyzer Explosive
 Under 38° Permanenet Effective Acid Flamable Liquid
 Under 43° Short Term Base Flamable Solid
 Above 43° Long Term Corrosive Radioactive
 Non flammable Harmless Cancer causing Others
DEFLATE PERCENT
ABC Dust CO2 Foam Water Soil
COMPANY APPROVAL

Date

Name-Surname, Title

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Meclisi Mebusan Cad. Canfeda Çıkmazı No:3 90040 Kabataş / İstanbul - TÜRKIYE

Address: Mahatma Gandi Cad. No:78/2 06700 G.O.P./ANKARA - TÜRKIYE

Ayhan Sokak. A2/ C Blok 35410 Ege serbest Bölgesi Gaziemir/ İzmir - TÜRKIYE

Tel: (+90) (0312) 405 60 46 (2 Line) - Fax:(+90) (0312) 446 29 35 - (+90) (232) 291 00 41 (İzmir Office)

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