Online Assessment   This online assessment will help you determine whether NY Wa$teMatch's technical assistance service is appropriate for your organization. To schedule an on-site visit with NY Wa$teMatch, call us at 212-650-5832. You can also fax your request to 212-650-6272. NY Wa$teMatch gives priority to companies within the 5 boroughs.  Fields marked with    are required. Name   Title Company   Address City   State Select Armed Forces Americas Armed Forces Europe Alaska Alabama Armed Forces Pacific Arkansas American Samoa Arizona California Colorado Connecticut District Of Columbia Delaware Florida Federated Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Marshall Islands Michigan Minnesota Missouri Mariana Islands Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Islands Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Other Country   Zip Code   Telephone   Fax E-mail    How would you like NY Wa$teMatch to reply? (Select one) E-mail Telephone Fax Mail Estimated Volume of Waste Stream per month   Number of Containers     Size of Containers     Frequency of pickup     Monthly disposal cost     Name of carter     Total Volume per month   Estimated Composition of Waste Stream per month Materials Quantity/Unit (i.e. 7 cubic yards) % Volume       Additional Information/Comments