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CUSTOMERS’ CORNER / Request to deposit waste - place & date

Place of deposit: *		REVATECH Engis REVATECH Monsin WOS Genk WOS Hautrage
Reference of acceptance certificate:		* 123456/789012
Producer:		*
Desired date of deposit:		*
Quantity:		Kg *
Packaging:		*
Transporter:
Customer’s order reference:

*Required field.