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Indiana Materials Xchange Material Success and/or Removal Form
Use this form to document your successful exchanges or to remove materials from the IMX Database.  This is especially a great way for us to Track Your Successes!  It is brief and easy to use - and the information is valuable!  We use the information you send us to keep our database current and create a myriad of statistics including:  number of tons exchanged, disposal costs avoided, sales revenues generated, and end-use of the material exchanged.  We're just interested in RESULTS!  When our statistics are published or referenced, we don't use company names - just the statistical information we have been provided.  See Disclaimer. 
Contact Information
     Name:   
     Title:
     Company:
     Address:
     City:  State:   Zip/Postal Code:
     County:     
     Phone:     FAX:
     e-mail:

Material Code Number (i.e. A15-05)
   Code #:   Code #:
   Code #:   Code #:
   Code #:   Code #:


Reason for Completing this Form
   The material was successfully exchanged.
	   Amount Exchanged:  (indicate tons, lbs, gallons, etc.)
	   Avoided costs:	   Landfill costs	Purchase costs
	   Exchange value:	  (free, $/lb, $/gallon)  
	   Transportation paid by:	Lister	Responder

	   Please remove this listing from the IMX database
 	   I do not want to remove this listing, I am just documenting a successful exchange.	

    The material was disposed of.
    Other:  please describe. 


Additional Comments


Indiana Materials Xchange
IDEM-OPPTA
150 West Market Street, Suite 703
Indianapolis, IN 46204-2811

(800) 988-7901 (Indiana only)
(317) 232-8172
(317) 233-5627 (fax)
imx@idem.IN.gov
Technical Assistance Customer Service Survey
Questions or comments about this site may be addressed to: imx@idem.IN.gov
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