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Recycle Indiana > Indiana Materials Xchange > IMX: Material Success and/or Removal Form IMX: Material Success and/or Removal Form

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

The material was disposed of.

Other *please describe.

Please remove this listing from the IMX database

I do not want to remove this listing, I am just documenting a successful exchange.

Additional Comments