Pickup Request Form - State FInal.pdf
PDF 94 KB Posted
- Attached to
- **EXPIRED** Lamp, Ballast, Mercury Containing Equipment, and Battery Recycling, and PCB Disposal Services
- Contract number
- 505ENT-M15-LMPBLLSTR-01
- Issued by
- Wisconsin
About this file
This document is a Pickup Request Form from Lamp Recyclers, Inc., a Wisconsin-based recycling company located in Green Bay. The form serves as a service request mechanism for customers needing hazardous waste material collection services, requiring completion and submission via email to service@lamprecyclers.com or fax to (920) 403-1133. The form collects detailed generator information including EPA ID numbers, service and billing contact details, and specific pickup logistics such as site accessibility, loading dock requirements, and equipment needs.
The services covered under this form include comprehensive recycling pickup for various hazardous materials including fluorescent bulbs of multiple types (straight, compact, HID/mercury vapor, LED, UV/projection), batteries (alkaline, lead acid, NiCad, NiMH, lithium, lithium ion), ballasts and transformers (both PCB and non-PCB), electronic equipment, and other lighting materials. The form requires detailed inventory information including total bulb counts, packaging specifications (barrels, boxes, loose items), and weight estimates. Special handling requirements are noted for PCB ballasts, capacitors, and transformers which must use DOT-approved packaging. The company also provides various container and supply options including different sized barrels, drums, and barrel stands to facilitate material collection and transport.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1577_4.DOCX | DOCX document | |
| 1577_9.PDF | ||
| 1577_7.PDF | ||
| Lamp Recyclers Inc. - Contact List 3.2.2017.doc | DOC document | |
| Contract Pricing 7-11-2016.xlsx | XLSX spreadsheet | |
| 1577_6.PDF | ||
| User Guide-Lamp Ballast 2.21.17.docx | DOCX document |
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Text version
| Lamp | Recyclers, | Inc. | |
| 3055 | Holmgren | Way | |
| Green | Bay, | WI | 54304 |
800-558-1166 service@lamprecyclers.com
Pickup Request Form
| Thank | you | for | choosing | Lamp | Recyclers, | Inc. | for | your | recycling | needs. | Please | complete | this | form | in | its | entirety. | Once |
| finished, | please | this | form | to | service@lamprecyclers.com | or | fax | to | (920) | 403-1133. | If | you | have | any | questions |
please contact us at 1-800-558-1166.
Generator Name: __________________________________________________________ EPA ID # __________
Service Information
Contact Name: ______________________________________________________________________________
Phone 1: ______________________________________ Phone 2:_____________________________________
E-mail: ____________________________________________________________________________________
Address: ___________________________________________________________________________________
City: _________________________________________________ State: ______________ Zip: ______________
Billing Information
Contact Name: ______________________________________________________________________________
Phone 1: ______________________________________ Phone 2:_____________________________________
Address: ___________________________________________________________________________________
City: _________________________________________________ State: ________________ Zip: ____________
Pickup Details
Onsite Contact: ______________________________
Onsite Contact Phone: ________________________
Onsite Contact Cell: ________________________
Onsite Contact E-mail: ________________________
PO # _______________________________________
Receiving Hours: _____________________________
Dock/Service Door # __________________________
Special receiving or loading requirements:
Accessible to Semi: YES NO
On loading dock: YES NO
Lift gate needed: YES NO
Materials palletized: YES NO
Materials wrapped: YES NO
Pallet Jack needed: YES NO
Forklift Available: YES NO total # of bulbs # of Barrels to pickup # of Barrels to deliver # of boxes to pickup # of loose bulbs
Weight & Packaging
Numbers & Packaging
Non PCB Capacitor
Electronics -TV's/Monitors
Additional Notes:
4' Barrel Stand ______Stands
8' Barrel Stand ______Stands
5 Gallon Drum ______Drums
55 Gallon Drum ______Drums
8" Barrel ______Barrels
4' Barrel ______Barrels
Alkaline
Lead Acid
Supplies Needed
Lithium
2'/Misc. Barrel ______Barrels
Lithium Ion
Electronic Equipment
ALL PCB Ballasts, Capacitors or Transformers require DOT-Approved Packaging
PCB Transformer
Materials to be Picked-Up
NiCad
Compact Fluorescent
U-Shape/Circular
Spot/Flood/Incandescent
HID/Mercury Vapor
Ballast
Non PCB
PCB Ballast
Additional Notes:
Item
Straight Fluorescent 4' or less
Straight Fluorescent 5' or more
Batteries
Broken Bulbs
LED
UV/Projection
NiMH PCB Capacitor
Non PCB Transformer
File details come from the government source that posted it. Updated .