COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Recyclable Materials Biennial Report - Page 1 Instructions Complete this form if you recycle more than 100 kilograms (approximately 220 pounds or 27 gallons) per month of recyclable material under a claim that the material qualifies for an exclusion or exemption pursuant to H&SC §25143.2. Facilities that recycle at the same location where the material is generated (on-site recyclers), and facilities that recycle materials generated at an off-site location (off-site recyclers), must complete this report. Persons who send materials to another location to be recycled, and who do not recycle material on-site under a claim to an exclusion or exemption provided in H&SC §25143.2, do not need to complete this report. Complete a separate Page 2 of this report for each individual recyclable material. Off-site recyclers must complete one report for each generator from whom they receive recyclable materials and provide a copy of the completed report to the generator of the material recycled. Please number all pages of your submittal. (Note: Numbering of these instructions follows the UPCF data element numbers on the form.) 1. FACILITY ID NUMBER - This space is for agency use only. 2. EPA ID NUMBER - Enter your facility's 12 -character U.S. Environmental Protection Agency (U.S. EPA) or California identification number. For facilities in California, the number usually starts with the letters "CA." If you do not have a number, contact the DTSC Telephone Information Center at (916) 324-1781, (800) 61 -TOXIC or (800) 618-6942, to obtain one. 3. BUSINESS NAME - Enter the complete Facility Name. 500. BEGINNING DATE OF REPORTING PERIOD - Enter the beginning date of the reporting period for this report. This report is for two calendar years and is due on July 1 of every even -numbered year. 501. ENDING DATE OF REPORTING PERIOD - Enter the ending date of the reporting period for this report. 502. ON-SITE RECYCLING - Check "Yes" if the recycling facility recycles more than 100 kilograms per month of recyclable material generated on-site under a claim that the material qualifies for an exclusion or exemption pursuant to H&SC §25143.2. Check "No" if the recycling facility does not recycle on-site. 503. OFF-SITE RECYCLING - Check "Yes" if the recycling facility recycles more than 100 kilograms per month of recyclable material under a claim that the material qualifies for an exclusion, or exemption pursuant to H&SC §25143.2, and that material was received from one or more off-site locations. Check 'No" if the recycling facility does not recycle material generated off- site. 504. OFF-SITE GENERATOR NAME - If the generator is different from the recycler, enter the name of the person or facility that generated the recyclable material. Complete a separate report for each generator. 505. OFF-SITE GENERATOR EPA ID NUMBER - Enter the generator's 12 -character U.S. Environmental Protection Agency (EPA) identification number. 506. OFF-SITE GENERATOR STREET ADDRESS - Complete items 506-510 for each generator of recyclable material. 507. OFF-SITE GENERATOR PHONE NUMBER 508. OFF-SITE GENERATOR CITY 509. OFF-SITE GENERATOR STATE 510, OFF-SITE GENERATOR ZIP CODE 511, OFF-SITE GENERATOR MAILING ADDRESS - Complete items 511-514 if the mailing address for the off-site generator 512. CITY FOR MAILING ADDRESS is different from the street address. 513. STATE FOR MAILING ADDRESS 514. ZIP CODE FOR MAILING ADDRESS SIGNATURE OF CERTIFIER - The business owner/operator of the recycling facility shall sign in the space provided. This signature certifies that the signer believes that the information submitted is true, accurate, and complete. 515. DATE CERTIFIED - Enter the date that the certification was signed. 516. NAME OF DOCUMENT PREPARER - Enter the name of the person who prepared the report. 517. CERTIFIER NAME - Enter the full printed name of the certifier. 518. CERTIFIER TITLE - Enter the title of the person signing the report. UPCF (1199) Hwrrecyc 214 www.unidocs.org Rev. 02/16/00