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If you are interested in reducing the current costs of your environmental services, please take a couple of minutes to register now by completing the form below to GET IN THE LOOP!

By filling out the form, we will include you into our mailing list and keep you posted on how to stay in compliance with VOC regulations while minimizing or even eliminating your need to focus on the environmental concerns faced by your organization.

Note: Anything highlighted in red must be filled out

Name
Company Name
Phone #	Ext.
E-mail
Industry Sector	Automotive Chemical Dry Cleaning Manufacturing Ohter Pharmaceutical Printing/Graphics
Click on any of the following environmental products and services your organization uses: Hazardous and Non Hazardous Waste Services Environment Health and Safety Services Absorbents Blanket Wash & Ink Wipers

Referred By	Associations G&K Government Agencies Other Tradeshows
DPC	Toronto East Toronto West Brampton Oshawa Barrie Sudbury Sault Ste. Marie Cambridge Hamilton Windsor London Kingston Ottawa/Whistle Kleen Quebec Montreal Grandby Halifax
# of Employees	10 or Less 10 - 20 20 - 40 40 - 50 50 - 100 100 or More
Title
Website
Address
Address (cont.)
City
Province/State	Alabama Alaska Arizona Arkansas Armed Forces Asia Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Postal/Zip Code
Country	Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Islands Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S. A. R Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau S.A.R. F.Y.R.O. Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda St. Kitts And Nevis St. Lucia St. Vincent & Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Saint Helena Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Isl Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (Br) Virgin Islands (US) Wallis And Futuna Yemen Yugoslavia Zambia Zimbabwe
Fax #
ISO	ISO 9000 ISO 14000

Hazardous Waste Classes	111 112 113 114 121 122 123 131 133 134 141 142 143 144 145 146 147 148 149 150 211 212 213 221 222 231 232 233 241 242 251 252 253 254 261 262 263 264 265 266 267 268 269 270 281 282 331
Hazardous Waste Usage	-> Select Usage <- 1 - 3 barrels 3 - 5 barrels 5 - 10 barrels 10 or more barrels -> Select Occurrence <- per day per week per month per year

Which of the following Absorbents and Spill products does your operation utilize? Pads Mat-Rolls Socks Barrel Top Pads

Does your company use outside consulting Services for your environmental needs, if so select from the following Services?

Audits - including Compliance, Phase 1, due diligence, designtated and hazardous substances, and management systems Management System development and implementation (ISO 14004, 9001 and OHSAS 18001) Environmental Aspect and Impact assessments & Research Training - including WHMIS, Transportation of Dangerous Goods, Auditing, Waste Minimization, Due Diligence and Emergency Response Air Emission Permitting and Emissions Calculations (including NPRI & Greenhouse Gas Emissions) Air Dispersion Modeling (including US EPA AERMOD, Screen 3) Operations Reviews and Risk Assessments Sustainable Development Leadership in energy and Environmental Design (LEED) facilitation

Blanket Wash Usage	1 barrel 1 - 3 barrels 5 or more barrels  per month
Ink Wiper Usage	100 or less 100 - 400 500 - 1000 1000 - 3000 3000 - 8000 8000 or more  per week
Type of Printer	Flexographic Silk Screen Rotogravure Typographic Lithographic Newspaper
	Full Web Half Web Sheet Fed Coldset Web Heatset Web 18" or Less 19"-30" 31"-42" 43" or More Digital Film/Plates Aqueous Solvent
Are you interested in participating in a recycling program where spent solvents from your wipers are remanufactured into a new blanket wash? Yes No
If you are interested in our solvent recycling program but require more information, please check the following box: