Fillable Delaware Annual Recycling Activity Report Form printable pdf download

Delaware Annual Recycling Activity Report Form

2015

EPORT

ORM FOR

ALENDAR

EAR

If you have any questions about this form, please call the third party consulting firm,

DSM Environmental, at (802) 674-2840 x103

Company Information

Company

Subsidiary of

Mailing Address

Contact Name

City

State

Zip

Title

Physical Address

Phone

Same as mailing

FAX

City

State

Zip

Company Type:

Recyclables Collector/Hauler

Processor

End User

Municipality

Self Marketing Generator

Other _______________________

If you use a waste hauler or recycling service(s) to collect your recyclables please indicate the company (or companies) name, address and contact

____________________________________________________________________

information and no further information is required:

_________________________________________________________________________________________________________

Materials Recycled

(between January 1 and December 31, 2015)

Approx. percent

Please list (as available) the company or location

Percent

of material

where you send the material for

Commercial

Residential

originating from

Recycling, Processing or End Use

Delaware ONLY

1. List specific material type: Corrugated; Newspaper; Office Paper; Mixed Paper; Glass; Plastic Film/Shrink Wrap; Retail Bags; Plastic Containers;

Aluminum Cans; Pallets (recycled, not rebuilt); Mixed Recyclables/Single Stream; White Goods/Appliances; Leaf and Yard Waste (including branches <

4"); Trees and Branches (but no landclearing debris); Clean Wood (but no construction debris);Tires (recycled not burned); Lead Acid Batteries; Other

Batteries; Oil Filters; Textiles; Electronics; Florescent Bulbs; Carpet; Fats-Oil-Grease; Food Waste; Mixed Plastics (Non-Industrial); Mattresses.

2. This information is important so that DSM does not double count material that is handled by another recycler that participates in our survey. If

you broker direct to an end user outside of DE, and you would prefer not to list them, just list "End User outside of DE." We may call for details.

3. For companies that receive recycling material from outside the state of Delaware, estimate the percent of material from Delaware only.

Non-Disclosure

The information provided is confidential

Yes

DSM Environmental Services, Inc. (DSM) will hold confidential any information and data provided to us which you specify as confidential, as part of the Delaware

Statewide Municipal Recycling Annual Report that DSM is conducting for the Delaware Recycling Public Advisory Council (RPAC). The purpose of the

study is to develop reasonable and professional estimates of the quantity of material recovered for recycling from residential and non-residential activities located in

Delaware, and to ensure no double counting of material occurs. Data provided to DSM will be aggregated with all other material quantities reported to develop a single,

annual quantity (in tons) of material recycled for each material type. DSM agrees not to release, divulge or report any individual data or information reported to any

party, including RPAC, and will maintain complete confidentiality with the data using it only for aggregate material reporting.

DSM Environmental Services, Inc.

P.O. Box 2 • Windsor, VT 05089

ax completed form to DSM

802.674.2840 • 802.674.6915 fax