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i UNIFIED PROGRAM CONSOLIDA'T'ED FORM HAZARDOUS WASTE RECYCLABLE MATERIALS REPORT—PAGE 2 j FOR EXCLUDED OR EXEMPTED MATERIALS ONLY one description per material recycled,attach additional pages,if needed TOTAL NUMBER OF RECYCLABLE MATERIALS 2 579 P.R.2—of Z FACILITYID# I BUSINESS NAME(Sa.e as FACRITY NAME or DBA—Doing Business As) 3 PReMLIM rsNtty IV.RECYCLABLE MATERIAL INFORMATION A.DESCRIPTION RECYCLABLE 520 COMMON NAME OF RECYCLABLE 521 QUANTITY DURING 522 523 MATERIAL NUMBER MATERIAL TWO YEAR REPORTING UNITS [Va.Gallons ❑c. Tons PERIOD I [Ib.Pounds ❑d.Kilograms RECYCLABLE MATERIAL DESCRIPTION 524 T—t4b0Slr'1k(AL GEIEI� .4L. RECYCLING PROCESS AND BENEFICIAL USE OF RECYCLABLE MATERIAL 525 t5-1' LLA-rLp,>J - wE 6CYe LE .4b RE056- 114I5 02000e--P' AUTHORIZING PROVISION OF HSC SECTION 25143.2 526 BASIS FOR CLAIM TO AN EXCLUSION OR EXEMPTION 27 V%S /A&AVISLVAL 2S RlFe_Y«9D 4AAb v5t$4) A7- Tr4E SAMA FAe-l:c,rTY .4TwKae-H x r w,as 61,51ve)ZAT-ap PRODUCT AND CONSTITUENT INFORMATION: OFFSITE ONLY Only complete if recyclable material was used to make or substitute for a product and operating pursuant to HSC Section 25143.2(b)or(d)(5)or(6). HAZARDOUS CONSTITUENT LIST FINAL PRODUCT(S)MADE FROM THIS HAZARDOUS CONSTITUENT RECYCLABLE MATERIAL AND BENEFICIAL USE In Recyclable Material In Final Product OF FINALPRODUCT(S) 528 529 531 533 UNITS 530 UNITS 532 ❑a percent❑b ppm ❑a percent ❑b ppm 534 535 537 539 UNITS 536 UNITS 538 ❑a percent❑b ppm ❑a percent❑b ppm 540 541 543 545 UNITS 542 UNITS 544 ❑a percent❑b ppm ❑a percent❑b ppm 546 547 549 551 UNITS 548 UNITS 550 ❑a percent❑b ppm ❑a percent❑b ppm If more than four constituents are recycled,attach additional sheets using this same format. V.DOCUMENTATION OF KNOWN MARKET (Offsite recyclers only) _ .....__ ......._._ .._.... . .._..... ......... -- --- —-- ❑ DOCUMENTATION IS ATTACHED: Offsite recyclers must attach documentation that there was a known market for disposition of the recyclable 552 material and any products manufactured from the recyclable materials and provide copy of this report to the generator when the report is submitted to the CUPA. SC Section 25143.10(a)(3)(A UPCF(1/99 revised)