Environmental :: Services

Lab Packs

	Remediation & Consulting
	Lab Packs

If you have not already completed a Lab Pack Laundry List, click HERE to open and complete this mandatory form before continuing!

LAB PACK GENERATOR QUESTIONNAIRE
(For HELP completing the fields on this form, click HERE.)

SECTION 1: GENERATOR INFORMATION

GENERATOR NAME GENERATOR ADDRESS

CITY STATE ZIP

GENERATOR PHONE GENERATOR FAX

CONTACT TITLE

TYPE OF BUSINESS

FEDERAL ID NUMBER (if applicable)

SMALL QUANTITY GENERATOR YES NO

HAVE YOU EVER HAD A LAB PACK DONE BEFORE YES NO

IF YES, WHEN

IF YES, BY WHOM

SECTION 2: DESCRIPTION OF WASTE

TYPE OF WASTE

IF OTHER, TYPE

INVENTORY AVAILABLE YES NO

ANY REACTIVE WASTES YES NO

ANY UNKNOWNS OR UNLABELED BOTTLES YES NO

SECTION 3: LOCATION OF WASTE
ARE CHEMICALS IN ONE LOCATION YES NO
INDOORS OR OUTDOORS, DESCRIBE LOCATION
SIZE OF WORKING AREA (SQ. FT.)
IF THE WORK AREA IS SMALL, IS THERE ANOTHER LOCATION THE WASTE CAN BE MOVED TO GIVE MORE WORKING ROOM?

WHAT FLOOR ARE CHEMICALS ON
ARE ELEVATORS AVAILABLE YES NO
IS THERE A LOADING DOCK YES NO
IS THERE A FORKLIFT FOR USE YES NO
IN THE AREA OF THE CHEMICALS ARE THE FOLLOWING AVAILABLE
LIGHT	YES NO
HEAT/AIR CONDITIONING	YES NO
ELECTRICITY	YES NO
RUNNING WATER	YES NO
FUME HOOD	YES NO
IS WORKING AREA NEAR EQUIPMENT LOADING POINT?	YES NO
IF NOT, HOW FAR MUST WE MOVE EQUIPMENT?

LEAD OFFERED BY: (Sales Rep)

COMPANY:

PHONE:

(Click here to send this form to EWP.)