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f <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> RECYCLABLE MATERIALS REPORT-PAGE 1 <br /> FOR EXCLUDED OR EXEMPTED MATERIALS ONLY <br /> + Page_of_ <br /> FACILITY iD# J7t. EPA 1D# a. <br /> CAD0054I5633 <br /> BUSINESS NAME(SweWFACEEHYNANIEorDBA—DokSBu0nessAs) 3. <br /> Pilkington <br /> DATES OF REPORTING PERIOD EEGINNINCs DATE 500. ENDING DATE sal• <br /> 01 Ian 2014 31 Dee 2011 <br /> I.TYPE OF RECYCLING ACTIVITIES <br /> If y6,please follow insinrcttans. <br /> 502. <br /> 1. Do you recycle more than 100 kg./month of excluded or 4 If YES, you are both the generator and rccycler. <br /> exempted recyclable material at the same location at which the ® YES ❑ NO Complete one Recyclable Materials Report. Do not <br /> material was generated(on-site recycling)? complete Parts II and V. <br /> 303. <br /> 2. Do you recycle more than 100 kg./month of non-manifested, 4 If YES, you are an off-site recycler but not the <br /> excluded recyclable materials received from an off-site location El YES Z 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 /> .11:-.OFF-SITE <br /> eport-- <br /> .11:-. )FF-SITE GENERATORDFRECYCLABLE <br /> MATERIAE <br /> Cgmplete only when the genera w is dt$erent from the recycler: <br /> OFF-SITE GENERATOR OF RECYCLABLE MATERIAL 504.t OFF-SITE GENERATOR EPA TD4 505, <br /> STREETADDRESS 506. PHONE M. <br /> CITY soa• STATS 509. ZIP CODE sto. <br /> MAILING ADDRESS(1.F DIFFERENT) <br /> CITY 512. STATE 513. ZIP CODE 514. <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 /> SIGNA CERTIFIER EDAT^�E 515. NAME OF DOCUMENT PREPARER 515. <br /> 1...� V-2}-12 <br /> NAME OF IGNER(print) 517. TITLE OF SIGNER 518. <br /> Ben Cuthbertson Environmental Health&Safety Manager <br /> IIPCF(1/99)Hrvfrecyc 114 is-wiv,unidocs.org Rev.02/16140 <br />