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RECYCLABLE MATERIALS REPORTINGr6RM <br /> PLEASE PRINT OR TYPE ALL INFORMATION <br /> (See Instructions on reverse) <br /> IV. MEETING EXEMPTIONS OR EXCLUSIONS. <br /> A. Was the racycier of the material the same as the generator of the material? `U' Yes ❑ No <br /> 1t No then complete items 1 and 2. If Yes then proceed to W.B. <br /> 1. Include documentation that there was a known market for disposition of the recyclable material and any products <br /> manufactured from the recyclable material,AND <br /> 2. Provide a completed copy of this form to the generator on or before July 1, 1992, and every two years thereafter. <br /> B. Indicate the subdivision(s), paragraph(s), and subparagraph(s) (if applicable) of Section 25143.2 that served as the <br /> basis for your claim of exemption or exclusion. Example:25143.2(d)(2)(C). <br /> as-1q3 ,Z C 6) Cz) aNalow zs) Is ,z Cd) C7 ) (A� (zz) <br /> V. DESCRIPTION OF THE RECYCLABLE MATERIAL. <br /> A. Provide a general.description of the recyclable material that was used in the recycling process. <br /> 1900 -';41LVZAT0Sc..tL�i)o IC ACIP AAD 46T& 134114 <br /> B. Provide a general description of the product(s)that resulted from the recycling process. <br /> Fcgk6uS Sutmf'c AtJ9 UNSATYR41" SQUOIel( AUN 4N6 It 0412t 84TO <br /> C. Identify the constituents and their approximate concentrations which rendered the recyclable material hazardous, and <br /> the final use or the approximate concentrations of those constituents in the final product. <br /> CONSTITUENT NAME APPROXIMATE FINAL USE OR <br /> CONCENTRATION IN APPROXIMATE <br /> RECYCLABLE MATERIAL CONCENTRATION IN FINAL <br /> PRODUCT <br /> 'U L 2r' ACID <br /> D. Describe how the recyclable material was beneficially used when recycled in this manner. <br /> Acle 84TH ufe E 7-9AAWA F'QA4 41140K,Z GU0�2KGJE�KSr 73 Mi.di»IVAf Z yEAk'i . <br /> �E2nuus atiPATG USES Got L�4TE/LT2E47naEN� �yAntrDE Nr urrtau rid �5ee EncLq� <br /> VI. CERTIFICATION BY THE OWNER OR OPERATOR OF THE RECYCLING FACILITY. <br /> I certify under penalty of law that this document was prepared under my direction or supervision in accordance with a system <br /> designed to assure that qualified personnel property gather and evaluate the information submitted. Based on my inquiry of the <br /> person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the <br /> best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false <br /> inform lion, inclu ing the possibility of fines and imprisonment for knowing violations. <br /> ti - NIaNN&ic VicF /&s. oP P01. 0&A9T,ow5 <br /> Name(Print or Type) Title <br /> Signature Data Signed <br /> Rev:511&92 <br /> Page 2 ort <br />