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Used IBC Collection Request Form
Company Name
Contact Name (First, Last)
Email
Phone
Address
Pick Up Hours
Original IBC Filler (company who originally filled the IBC)
Total Number of Non Regulated (total # of IBCs which last contained a non regulated material)
Total Number of Regulated (total # of IBCs which last contained a DOT regulated hazmat material)
Chemical Trade Name/DOT Shipping Info/UN# for Hazmat
Sales Rep
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Terms & Conditions
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