Four County Solid Waste District

 
Industrial Survey

 

 
Commercial and Residential Survey

 

 

Industrial 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 Recycled

Industrial Tons Incinerated

Industrial Tons Composted

Food

Glass

Metals Ferrous

Metals Non-Ferrous

All Other Paper

Plastics

Rubber

Textiles

Wood

Other (specify)

Grand Total:

Company Information

Company

Address:

Zip code

State

City:

Title:

Name:

E-mail:

Phone: