MT2-Outdoor Range Questionnaire

Name of Facility: *
Physical Address of Range: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
reply to email
Mailing address if different

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Point of Contact: Full Name *

First Name Last Name
Title
Phone Number *

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
E-mail Address *
example@example.com
PROMOTION CODE
How did you hear about MT2?
Range Description: Range #1
Number of Positions
Backstop Type

Soil/Sand Granulated Rubber
Height of Backstop
Width of Backstop
Ammo Type

Lead Frangible Mixed
Type of Range

Rifle Pistol Trap/Skeet
Range Description: Range #2
Number of Positions
Backstop Type

Soil/Sand Granulated Rubber
Height of Backstop
Width of Backstop
Ammo Type

Lead Frangible Mixed
Type of Range

Rifle Pistol Trap/Skeet
Range Description: Range #3
Number of Positions
Backstop Type

Soil/Sand Granulated Rubber
Height of Backstop
Width of Backstop
Ammo Type

Lead Frangible Mixed
Type of Range

Rifle Pistol Trap/Skeet
Range Description: Range #4
Number of Positions
Backstop Type

Soil/Sand Granulated Rubber
Height of Backstop
Width of Backstop
Ammo Type

Lead Frangible Mixed
Type of Range

Rifle Pistol Trap/Skeet
Range Photos Please provide:
1. Ground level digital photos of the range and its features
2. Map/sketch of the layout of the ranges at your facility
Upload a File
pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif Cancel of
Range Access: Hours of Access for Range Maintenance
Lead Recovery History: Date of Last Lead Recovery
Previous Provider
Scrap amount paid for recycled lead
Annual pounds of recycled shells
Services Requested

	Annually	Biannually	Quarterly	Monthly
Lead Recovery
Brass Recovery
Range Waste Disposal & Mgt.
Add Additional Berm Media
Add Fire Retardant to Berm
OSHA/EPA Safety "pre-audit"
Other Maintenance

Range Assessment Environmental Stewardship Plan Soil Treatment Construction or Demolition Range Upgrades
Would you be interested in MT2 performing an environmental review of your range Best Management Practices and providing a written report with recommendations?

Yes No
Should be Empty:

Range Description: Range #1

Range Description: Range #2

Range Description: Range #3

Range Description: Range #4

Services Requested