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MANIFEST INFORMATION SHEET |
Note: All of the following information must be completed before pickup will be scheduled. Signed proposal must accompany paperwork. Please print off the form and fill in each field. Following, please fax the information to the appropriate fax number as listed below.
| TRANS-CYCLE INDUSTRIES, INC.
101 Parkway East P.O. Box 765 Pell City, AL 35125 Phone: (205) 338-9997 Fax: (205) 338-9979 |
TCI, INC.
39 Falls Industrial Park Road Hudson, New York 12534 Phone: (518) 828-9997 Fax: (518) 828-9979
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| BROKER INFORMATION: | GENERATOR INFORMATION: |
| Name: ________________________________________ | Name: ______________________________________ |
| Address: _____________________________________ | Address: ____________________________________ |
| City, State, Zip: ________________________________ | City, State, Zip: _______________________________ |
| EPA ID #: ____________________________________ | EPA ID #: ___________________________________ |
| Contact: _____________________________________ | Contact: ____________________________________ |
| Phone: ______________________________________ | Phone: _____________________________________ |
| Fax: ________________________________________ | Fax: _______________________________________ |
| PICKUP SITE INFORMATION: | BRIEF DRIVING DIRECTIONS: |
| Name: ______________________________________ | _____________________________________________
_____________________________________________ _____________________________________________ _____________________________________________ |
| Address: ____________________________________ | |
| City, State, Zip: _______________________________ | |
| EPA ID #: ___________________________________ | |
| Contact: ____________________________________ | |
| Phone: _____________________________________ | |
| Fax: _______________________________________ |
| TCI RESPONSIBILITIES: |
| Sample on Site | Analysis | Drain on Site |
| Field Dismantling | Loading | Manifest |
| Transportation | Labels | Disposal Documents Required |
ITEMS TO BE SHIPPED
Note: Each item (drums included) must be listed individually. If the items are drained, show empty weights and zero gallons.
| Item Description (Transformer, Small Caps, etc.) | PCB Level (ppm) | Container Type | Date Removed from Service (Must have if over 49 ppm PCB's) | Gal. | Lbs. | Gen. Ref. # | Serial Number | Size (KVA, 55 Gal., etc.) | Dimensions |
| To be Completed by TCI: | Transporter: | Pickup Scheduled For: |