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RECYCLABLE MATERIALS REPORTING r ,jRM <br />LEASE PRINT OR TYPE ALL INFORM:. T' N <br />(See Instructions on reverse] <br />W. ME=-nNG EXEMPTIONS OR EXCLUSIONS. <br />A. Was the recycter of the material the same as the generator of the material? & Yes Q No <br />If No then complete items 1 and 2. If Yes then proceed to /V.9. <br />1. Include documentation that there was a known market for disposition cf the recyclable material and any products <br />manufactured from the recyclable material, AND <br />2. Provide a completed copy of this form to the generatoran or before July 1, 1992, and every two years thereafter. <br />B. indicate the subdivision(s), paragraph(s), and subparagraphs) (if applicable) of Section 251432 that served as the <br />basis for your claim of exemption or exclusion. Example: 251432(d)(2)(C). <br />25143.2 (b) (3) and 25143.2 (c) (2) <br />V. DESCRIPTION OF THE RECYCLABLE MATERIAL <br />A. Provide a general description of the recyciabfe material that was used in the recycling process. <br />The recycleable material is the clear water discharge from an ultra filtration <br />unit. The discharge is returned to the process on a continuous basis. <br />B. Provide a general description of the product(s) that resuited from the rec Ging process. <br />The products resulting from the ultra filtration process is a clear water <br />material and a water based paint material. <br />C. identify the constituents and their approximate concantraticns wnicri rencered the recyclable material hazardous, and <br />the final use or the approximate concentrations of those constituents in the Tina! product - <br />CONSTITUENT NAME <br />APPgCX!MA T <br />CCNCENT RATiCN 1N <br />RECYCLAELZ- MAT=" ---JAL <br />FiNAL USE OR i <br />i APPROXIMATE <br />C^,NCENTP,ATiON IN FINAL <br />PRCOUCT <br />N -But Alc-oFo-1 <br />0.28% <br />1 0.14% I <br />Butyl Cellosolve 1 <br />0.16% <br />1 0.08% I <br />ButXl Carbitol-1 <br />0.17% <br />1 0.09% i <br />1 <br />I I <br />0. Describe how the recyclable material was beneficially usad when recyded in this manner. <br />The recycleable material is continuously returned to the process which <br />eliminated the use of new water being added to the process. <br />VI. CERTIFICATION BY THE OWNER OR OPU ATCR OF THE RECYCLING FACILITY. <br />I certify under penalty of law that this document was prepared under my diroctfcn cr supervision in acc'rdance with a system <br />desicned !o assure that qualified personnel orc-edy gather and evaluate the informaticn submitted. Based on my inquiry of the <br />person or 'Arsons who manage the system, or those directly respcnsi--ie for gathering the informaticn, the information is, to the <br />best of my knowledge and belief, true, accurate, and complete. i arc aware that there are significant penalties for submitting false <br />informaticn, including the possibility of fines and imprisonment fcr knowing viciaticns. <br />Kerry Arnold <br />Name (Print ar Type) <br />Signature <br />Safety and Risk Manager <br />Title <br />Cate Signeo <br />Rev: 517&92 Page 2 of 2 <br />