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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> t RECYCLABLE MATERIALS REPORT—PAGE 2 <br /> FOR EXCLUDED OR EXEMPTED MATERIALS ONLY <br /> (one description per material recycled,attach additional pages,if needed) <br /> TOTAL NUMBER OF RECYCLABLE MATERIALS 2.r 519 Page 2.of 2 <br /> FACILITY ID# 1 BUSINESSNAME(SameasFACILITY NAMEOrDBA—Doing Business As) 3 <br /> PREMIER P11V1,5M1iVE <br /> IV.RECYCLABLE MATERIAL INFORMATION <br /> A.DESCRIPTION <br /> RECYCLABLE 520 COMMON NAME OF RECYCLABLE 521 QUANTITY DURING 522 523 <br /> MATERIAL NUMBER MATERIAL TWO YEAR REPORTING UNITS [Pa.Gallons ❑c. Tons <br /> �ItLA At-KALzlva aP-erAm PERIOD <br /> [I b. d <br /> e.G.y� b.Pounds Kilograms <br /> GoLV66&O`r f�I�1CTV121= �V <br /> RECYCLABLE MATERIAL DESCRIPTION 524 <br /> Reir r,4Pit< grtrPPawx-rq b=L qgL- t�L-ja Q�c)1, 7-mmxszo✓v 5 P.41A17- Rtawte3 <br /> RECYCLING PROCESS AND BENEFICIAL USE OF RECYCLABLE MATERIAL 525 <br /> 025T(LLATzo, /-- w o- u, 04 NJ) t2 VS 0 V Maty PjZ0 bUC7— <br /> AUTHORIZING PROVISION OF HSC SECTION 25143.2 526 BASIS FOR CLAIM TO AN EXCLUSION OR EXEMPTION 527 <br /> tars MkremyAL zs av---LEO AA-14 R6OSts) <br /> was ea l5A- XaAT-G <br /> B.PRODUCT AND CONSTITUENT INFORMATION: OFFSITE ONLY <br /> 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). <br /> HAZARDOUS CONSTITUENT LIST FINAL PRODUCT(S)MADE FROM THIS <br /> HAZARDOUS CONSTITUENT RECYCLABLE MATERIAL AND BENEFICIAL USE <br /> In Recyclable Material In Final Product OF FINALPRODUCT(S) <br /> 528 529 531 533 <br /> UNITS 530 UNITS 532 <br /> ❑a percent❑b ppm ❑a percent ❑b ppm <br /> 534 535 537 539 <br /> E <br /> UNITS 536 UNITS 538 <br /> ❑a percent❑b ppm ❑a percent❑b ppm <br /> i 540 541 543 545 <br /> UNITS 542 UNITS 544 <br /> ❑a percent❑b ppm ❑a percent❑b ppm <br /> 546 547 549 551 <br /> r <br /> UNITS 548 UNITS 550 <br /> ❑a percent❑b ppm ❑a percent❑b ppm <br /> If more than four constituents are recycled,attach additional sheets using this same format. <br /> V.DOCUMENTATION OF KNOWN MARKET..(Offslte,recyclers only) _ <br /> ❑ DOCUMENTATION IS ATTACHED: Offsite recyclers must attach documentation that there was a known market for disposition of the recyclable 552 <br /> material and any products manufactured from the recyclable materials and provide copy of this report to the generator when the report is submitted to <br /> the CUPA. (HSC Section 25143.10 a(3)(A)) <br /> i' <br /> i <br /> LJPCF(1/99 revised) <br />