800.909.9709
www.AirCycle.com
[25]
Bulb Eater® Manual
Pick-Up Request Form
Schedule a Pickup online at
www.aircycle.com/services
Date:
Company:
Company:
Address:
Address:
City/State/Zip:
City/State/Zip:
Contact:
Accounts Payable
Contact:
Contact E-mail:
Accounts Payable
Phone:
Contact Phone:
Accounts Payable E-mail:
Contact Fax:
EPA ID#:
Alternate Contact/Phone:
PO#:
A truck with a lift gate is required to pick up the material.
Yes
No
Is there a forklift available to load the material onto the truck?
Yes
No
Quantity
The material will need to be manually loaded onto the truck.
Yes
No
55 Gallon Steel Drums
Note: manpower charges for loading may apply
4' Fiber Drums
A full size tractor-trailer can fit into the loading dock.
Yes
No
4' Lamp Boxes
Height and length restrictions for the loading dock are:
8' Lamp Boxes
Where is the material stored within your facility:___________________________________
5 Gallon Poly Pails
Available Loading Hours: _________________________
Failure to complete this section may delay the scheduling of service to your facility
Material To Be Picked Up:
Lamps:
Quantity
55 Gallon
Drums of Crushed Lamps
55 Gallon
Drums of Crushed Lamps w/CFLs
Quantity
4ft. or Less Fluorescent Lamps
Steel Drums
(55 Gallon)
5ft. - 8ft. Fluorescent Lamps
Cardboard Boxes
9ft. or More Fluorescent Lamps
4' Fiber Drums
(85 count)
U-Bend / Circular
4' Fiber Drums
(185 count)
Compact
w/o Ballast
8' Fiber Drums
(85 count)
HID
(Mercury Vapor, Metal Halide, High-pressure Sodium)
Other:
Shattershield / Coated
Total of Pallets:
Incandescent
UV
Other Waste for Recycling Pick Up:
Office Machinery (E-scrap):
Other Waste:
Special Instructions:
Non-PCB
PCB
Lead Acid
Mercury
The Material Is Packaged In:
Poly Pails
(5 Gallon)
Zinc Carbon
Alkaline
Lithium
NiMH
NiCad
Compact
w/Ballast
Weight
Ballasts:
Pick-Up Request Form
2200 Ogden Avenue, Suite 100 • Lisle, IL 60532
Generator Pick-Up Location
Generator Billing Information
Tel (800) 909-9709 • Fax (866) 909-6725 •
www.aircycle.com
Mixed
Batteries:
Weight
Failure to complete this section may delay the scheduling of service to your facility.
Replacement Containers:
Transportation Requirements section is required.
The marked material is to be properly identified and prepared for transportation and tender in accordance with all applicable statutes, ordinances, permits, rules and regulations of the Federal, State, and Local governments in whose
jurisdiction such material originates, passes through, or is tendered for delivery (certify for declare) under penalty of perjury that the foregoing is true and correct. Do not place any extraneous material or liquids in the drum. Presence of
these materials with the crushed lamp waste could result in very significant upcharges or potential return of the waste to yo ur facility. All final counts will take place at the end destination processing facility.
Please fill out this form completely and fax it to 866-909-6725 or e-mail to
Visit us at
AirCycle.com/services
to schedule your pickup online today!
