Commercial and Residential Survey
Four County Solid Waste District
Industrial Survey
Commercial and Residential Survey

Please submit the completed survey by April 1, 2002 or print and mail to Defiance Co. Environmental Services, 500 Court St., Suite E, Defiance, Ohio 43512 - or via fax to (419) 784-3268.  Attach a separate sheet if necessary to answer the following questions:

check here and go to Question 3 & 4.

Name

Location

Phone Number

Name

Location

Phone Number

Name

Location

Phone Number

If you need further definitions or have any questions, please contact our office.

Industrial Tons Composted

Industrial Tons Composted

Appliances

Rubber

**Scrap Tires (indicate if "tons" or "number" of tires below):

Passenger Car Tires

Truck Tires

Other Tires (Specify)

Glass

Household Hazardous Waste

Textiles

Wood

Metals Ferrous

Yard Waste

Metals Non-Ferrous

Used Oil

Cardboard

Other (specify)

All Other Paper

Grand Total:

Plastics

Company

Address:

City:

State

Zip code

Name:

Title:

Phone:

E-mail: