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UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS WASTE <br />RECYCLABLE MATERIALS REPORT - PAGE 2 <br />FOR EXCLUDED OR EXEMPTED MATERIALS ONLY <br />(One description per material recycled, Attach additional pages, if needed) <br />519. <br />TOTAL NUMBER OF RECYCLABLE MATERIALS <br />Page _ of <br />FACILITY ID# <br />I. <br />BUSINESS NAME (Same M FAC►LrrY NANM or DBA - Doing Business As) <br />IV. RECYCLABLE MATERIAL INFORMATION <br />A. DESCRIPTION <br />RECYCLABLE 520. <br />MATERIAL NUMBER <br />COMMON NAME OF RECYCLABLE 521, <br />MATERIAL <br />QUANTITY DURING 522, <br />TWO YEAR REPORTING <br />523 <br />UNITS ❑ a. Gallons ❑ c. Tons <br />PERIOD <br />❑ b. Pounds ❑ d. Kilograms <br />RECYCLABLE MATERIAL DESCRIPTION 524 <br />RECYCLING PROCESS AND BENEFICIAL USE OF RECYCLABLE MATERIAL 525, <br />AUTHORIZING PROVISION OF H&SC SECTION 25143.2 526. <br />BASIS FOR CLAIM TO AN EXCLUSION OR EXEMPTION 527. <br />B. PRODUCT AND CONSTITUENT INFORMATION: OFF-SITE ONLY <br />Only complete if recyclable material was used to make or substitute for a product and operating pursuant to H&SC Section 25143.2(b) or (d)(5) or (6). <br />HAZARDOUS CONSTITUENT CONCENTRATION <br />LIST FINAL PRODUCT(S) MADE FROM THIS <br />HAZARDOUS CONSTITUENT <br />In Recyclable Material In Final Product <br />RECYCLABLE MATERIAL AND BENEFICIAL USE <br />OF FINAL PRODUCT(5) <br />529. <br />529. <br />531, <br />533. <br />UNITS 530. <br />UNITS 532. <br />❑ a. percent ❑ b. ppm <br />❑ a. percent ❑ b. ppm <br />534. <br />535. <br />537. <br />539. <br />UNITS 536, <br />UNITS 539. <br />❑ a. percent ❑ b. ppm <br />❑ a. percent ❑ b. ppm <br />540. <br />541. <br />543. <br />545, <br />UNITS 542 <br />UNITS 544- <br />❑ a. percent ❑ b. ppm <br />❑ a. percent ❑ b. ppm <br />- 544. <br />547, <br />549. <br />551. <br />UNITS 549, <br />UNITS 550. <br />❑ a. percent ❑ b. ppm <br />❑ a. percent ❑ b. ppm <br />If more than four constituents are recycled, attach additional sheets using this same Format. <br />V. DOCUMENTATION OF KNOWN MARKET (Off-site reeycicrs only) <br />❑ DOCUMENTATION IS ATTACHED: Off-site recyclers must attach documentation that there was a known market for disposition of the recyclable material <br />and any products manufactured from the recyclable materials and provide a copy of this report to the generator when the report is submitted to the CUPA. <br />[H&SC Section 25143. 1 0(a)(3)(A)] <br />UPCF (1199) Hwfrecyc 314 www.unidocs.org Rev. 02/16/00 <br />