Dane County Department of Waste & Renewables

Business/VSQG & Agricultural Estimate Request Form

Company/Farm

Contact Name

Address

City

State

Zip

Phone

Fax

Estimate the total amount of dry chemical wastes, (powders, granulars, flowables) you have for disposal(in pounds)

Identify the chemical and indicate total content of each container

Estimate the total amount of liquid chemical wastes (emulsions, solvents, lead paints) you have for disposal(in gallons)

Identify the chemical and indicate how much liquid is in each container

Do you have any 30 or 55-gallon drums for disposal?

If yes, list number of containers and sizes.

Do you have any compressed gas cylinders?

If yes, indicate what type and size of each cylinder