AMERICAN ULTRA SPECIALTIES, INC
AMERICAN ULTRA SPECIALTIES, INC.
6855 Industrial Parkway
Hudson, Ohio 44236-1158 RECLAMATION FEASIBILITY SAMPLE DATA
330-656-5000
COMPANY: __________________________________________________
ADDRESS: ___________________________________________________
Street
___________________________________________________
City, State, Zip
CONTACT NAME: _____________________________________________ PHONE #: ____________________________
EMAIL: _______________________________________________________
PRODUCT: ________________________________________________ ___________________________________________
Brand Name Manufacturer
SAMPLE INFO: [ ] Used Sample Taken From: _________________________________________________________
[ ] New Sample Finished Product Required: ____________________________________________
PRODUCT QUANTITY: [ ] BULK _______________________________________
Amount per Period
[ ] TANKS _______________________________________
Amount per Period
[ ] DRUMS _______________________________________
Amount per Period
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