Remediation Services

Contact *

First Name

Last Name

Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Product Information

Finished Product Requested

T-Compliant Crude (0.3% or below)

Non-Detect Crude (Below LOQ)

T-Compliant Distillate (0.3% or below)

Non-Detect Distillate (Below LOQ)

Contract Information

Contract Length

One Time

Monthly

Quarterly

Other

Testing Requirements (required for tolling) *

Do you have a Full Panel COA?

Yes

No

*

Do you have a Potency COA?

Yes

No

Packaging Requirements

Container Size Requested

HDPE 1 kg

Aluminum 1kg

HDPE 5 Gallon Bucket

55 Gallon Drum

Other

Delivery Information

Delivery Date (When can you deliver product?)

MM

DD

YYYY

Requested in-hands date for finished goods

MM

DD

YYYY