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.II 1'_.{ ` 'eA ZA L7, J'iJS W AS fl_l�r �. FOR EXCLUDED OR EXEMPTED MATERIALS ONLY (one description per material rec cled,attach additionalages,if needed) ; TOTAL NUMBER OF RECYCLABLE MATERIALS 519 ... w Page 3—of�— FACILTIYID# 1TTTT=1PR',.,,Q.' BUSINESSNAME(Same asFACILITY NANMorDBA—Doing Business As) 3 RP'1e_5H1 p IV.RECYCLABLE MATERIAL INFORMATION A.DESCRIPTION RECYCLABLE 520 COMMON NAME OF RECYCLABLE 521 QUANTITY DURING 522 523 MATERIAL NUMBER MATERIAL TWO YEAR REPORTING UNITS [B'a.Gallons ❑c. Tons PERIOD C ❑b.Pounds ❑d.Kilograms RECYCLABLE MATERIAL DESCRIPTION 524 RECYCLING PROCESS AND BENEFICIAL USE OF RECYCLABLE MATERIAL 525 AUTHORIZING PROVISION OF HSC SECTION 25143.2 526 BASIS FOR CLAIM TO AN EXCLUSION OR EXEMPTION 27 IM%S /lAAV6t,1AL :95 K Ve-L_0 4AIh USCG A a N C a 9avg: Arr::. B.PRODUCT AND CONSTITUENT INF'ORMA.TION: 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 FINAL PRODUCT(S) 528 - 529 531 533 UNIT'S 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 sso ❑a percent❑b ppm ❑a percent❑b ppm If more than four constituents are recycled,attach additional sheets using this same fonnat. 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. (HSC Section 25143.10(a)(3)(A)) UPCF(1/99 revised)