Used oils

Please indicate below the quantity of used oils received by each of your UOMA NB collectors over the last year.

Please indicate below the quantity of used oils received by each of your NON-UOMA NB collectors over the last year.

Used glycol (antifreeze)

Please indicate below the quantity of used glycols (antifreezes) received by each of your UOMA NB collectors over the last year.

Please indicate below the quantity of used glycols (antifreezes) received by each of your NON-UOMA NB collectors over the last year.

Used filters

Please indicate below the quantity of used filters received by each of your UOMA NB collectors over the last year.

Please indicate below the quantity of used filters received by each of your NON-UOMA NB collectors over the last year.

Used oil and glycol (antifreeze) containers

Please indicate below the quantity of used oil and glycol (antifreeze) containers received by each of your UOMA NB collectors over the last year.

Please indicate below the quantity of used oil and glycol (antifreeze) containers received by each of your NON-UOMA NB collectors over the last year.

Used aerosol containers

Please indicate below the quantity of used aerosol containers received by each of your UOMA NB collectors over the last year.

Please indicate below the quantity of used aerosol containers received by each of your NON-UOMA NB collectors over the last year.

I, {signatoryName}, {signatoryTitle} confirm the information provided on this form is accurate and I recognize it could be subject to audits. The detailed files supporting this claim are available for consultation upon request.