Waste Form

Therm Tec, Inc.
P.O. Box 1105
Tualatin, Oregon U.S.A.

Phone No. (503) 625-7575

Fax No. (503) 625-6161

E-Mail : thermtec@earthlink.net

WASTE SURVEY Facility
Address
City State: Zip Code:

     Country
     Contact
       E-Mail
Phone No
     Fax No.
                    General Description & Type of Waste Material


Pounds Of Waste Per Hour:
Pounds Of Waste Per Day:
Expected Hours Of Burning:

FUEL AVAILABLE

Nat. Gas :

#2 Oil :

Other :

ELECTRICAL POWER

Volts :

Amps :

Phase :
Cycles:

Single
60 Hz

Three
50 Hz

ADDITIONAL INFORMATION REGARDING PROJECT: