COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS WASTE RECYCLABLE MATERIALS REPORT—PAGE I FOR EXCLUDED OR EXEMPTED MATERIALS ONLY Page�of 2 FACILITY I[]# � EPA III '- IF �A� D D 2 � 4� 010 �9 � CAR000268797 BUSINESS NAME(Same.FACILITY NAME or DBA—Doing Business As) 3 BEGINNING DATE 500 ENDING DATE S01 DATES OF REPORTING PERIOD 07/01/2020 07/01/2022 I.TYPE OF RECYCLING ACTIVITIES If yes,please follow instructions. 1. Do you recycle more than 100 kg/month of excluded or exempted 502 4 If YES,you are both the generator and recycler. recyclable material at the same location at which the material was YES ❑ NO Complete one Recyclable Materials Report. Do not generated(onsite recycling)? complete Parts II and V. 2. Do you recycle more than 100 kg/month of non-manifested, 503 4 If YES,you are an offsite recycler but not the excluded recyclable materials received from an offisite location ❑ YES ® NO generator. Complete a Rcoyolable Materials Report (offsite recycling)? I for each generator that sends you materials. --Businesses that only send recyclable materials to an offsite recyclers are not required to file this report.-- 11. OFFSITE GENERATOR OF RECYCLABLE MATERIAL Only complete when the generator is different from the recycler. OFFSITE GENERATOR OF RECYCLABLE MATERIAL 504 OFFSITE GENERATOR EPA 1D# 505 STREET ADDRESS 506 PHONE 507 CITY 508 STATE 509 ZIP CODE 510 MAILING ADDRESS(IF DIFFERENT) 511 CITY 512 STATE 513 ZIP CODE 514 III, CERTIFICATION SECTION 1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system,or those directly responsible for gathering the information,the information is,to the best of my knowledge and belief,true,accurate,and complete. SIGNATURE.OF CERTIFIER DATE 515 11 11 DOCUMENT PREPARER 516 01/14/2021 Matt Gosselin NAME OF SIGNER(print) Matt Gosselin 517 TITLE OF SIGNER Quality—EHS Manager 518 UPCF(12199 revised)