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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE JUL 0 9 2012 <br /> RECYCLABLE MATERIALS REPORT - PAGE 1 <br /> FOR EXCLUDED OR EXEMPTED MATERIALS ONLY <br /> Page_3_of_2 <br /> FACILITY IM �. EPA ID# 2. <br /> CAL 000182604 <br /> BUSINESS NAME(game m FAC=Y NAME w DBA—Doing Busmm As) 3. <br /> Premier Finishing <br /> DATES OF REPORTING PERIOD BEGINNING DATE Sm. ENDING DATE sou. <br /> 3.1.11 7/1/2012 <br /> I.TYPE OF RECYCLING ACTIVITIES <br /> If yes,please follow instructions. <br /> sot. <br /> 1. Do you recycle more than 100 kg./month of excluded or <br /> ex4 If YES, you are both the generator and recycler. <br /> exempted recyclable material at the same location at which the ® YES ❑ NO <br /> material was generated(on-site recycling)? Complete one Recyclable Materials Report. Do not <br /> complete Parts H and V. <br /> 503. <br /> 2. Do you recycle more than 100 kglmonth of non-manifested, 4 If YES, you are an off-site mit ycler but not the <br /> excluded recyclable materials received from an off-site location ❑ YES ❑ NO generator. Complete a Recyclable Materials Report <br /> (off-site recycling)? for each generator that sends you materials. <br /> —Businesses that only send recyclable materials to off-site recyclers are not required to file this report— <br /> OFF-SITE GENERATOR OF RECYCLABLE MATERIAL <br /> Complete only when the generator is different from the recycler. <br /> OFF-SITE GENERATOR OF RECYCLABLE MATERIAL 504. OFF-SITE GENERATOR EPA ID# sos. <br /> STREET ADDRESS sa. PHONE $ol. <br /> CITY soe. STATE sov. ZIP CODE sin. <br /> MAILING ADDRESS(IF DIFFERENT) sit. <br /> CITY sit. STATE 513. 1 ZIP CODE 114. <br /> III. CERTIFICATION SECTION <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in <br /> accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. <br /> Based on my inquiry of the person or persons who manage the system,or those directly responsible for gathering the information, <br /> the information is,to the best of my knowledge and belief,true,accurate,and complete. <br /> SIGNATURE OFC TIFIER DATE sus. NAME OF DOCUMENT PREPARER sib. <br /> t119 ) IZ_ i I Wendy Foulks <br /> NAME OF SIGNER(p ' 517 TrfLEO SIGNER sue. <br /> Wendy L Foulks Safety&Environmental MGR <br /> UPCF(1/99)Hwfrecyc 1/4 www.unidocs.org Rev.07116/00 <br />