Request for Special Burn
Waste No:
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Your waste will be incinerated at the following facility:
Facility:
Address:
Phone/Fax:
Email:
Pope Douglas Solid Waste Management
2115 South Jefferson Street, Alexandria, MN 56308
Phone: 800/972-6318 Fax: 320/763-9342
pdswmec@rea-alp.com
Please fill in the form and fill in the date you would like to drop off your waste at the facility. Forward
this form via FAX, mail, or email to the above facility. After the facility receives this form, it will contact
you to confirm your waste drop/pick-up dates. The disposal facility will make an effort to begin
incinerating your waste the same day it arrives.
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Name of Customer/Generator:
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Contact person:
Phone number:
Requested Waste Drop Date:
Waste to be Disposed of:
Description:
Type of container:
Number of containers:
One time disposal?
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On Going Disposal?
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Fax number:
FOR DISPOSAL FACILITY USE ONLY
Date Customer Contacted:
Scheduled Waste Drop Date:
Scheduled Burn Date:
Date Burn Completed:
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