New Brunswick-Collector registration renewal form

Collector registration renewal form

New-Brunswick
***** IMPORTANT NOTICE *****

Before completing the Collectors registration renewal form, please make sure you have the following documents in PDF format: your Civil and Environment Insurance Certificate and your Government issued Operation permit(s) (if applicable). All above mentioned documents must be attached to the following collectors registration renewal form.

From the moment we receive the following form signed and completed with all the required information, your Collector Agreement is automatically renewed.

Renewal for the year *
Select year
Your Atlantic Used Oil Management Association (New Brunswick) collector registration number:*
Number that appears on your Atlantic Used Oil Management Association (New Brunswick) collector certificate
Company legal name:*
Address*

Street address

Street address (line 2)

MunicipalityProvince/State

Postal/Zip Code
Telephone number*

Area CodePhone #
Extension

Contact person*
Title*
Contact person email address*

Confirmation EmailConfirm contact person's email address
Contact person for RI claims (if different)
Email address for RI claims contact person (if different)

Confirmation EmailConfirm email address for RI claims contact person

Has there been any changes to your spill prevention and containment measures (e.g. berm(s) or other confinement unit(s), regular inspections of storage units, proximity of absorbents, etc) in the past year?*

YesNo

Please list all changes introduced in the past year regarding your spill prevention and containement measures (e.g. berm(s) or other confinement unit(s), regular inspections of storage units, proximity of absorbents, etc).*

In the last year, have you aquired or opened new facility(ies) in New Brunswick where you intend to store collected Atlantic Used Oil Management Association (New Brunswick) products?*

YesNo

Please indicate the address of your new hazardous waste storage facility(ies) in New Brunswick where will be stored products for which you are registering with Atlantic Used Oil Management Association (New Brunswick).*
Do you have a permit or certificate for your facility(ies) in New Brunswick where you store products for which you are registering with Atlantic Used Oil Management Association (New Brunswick) NB?*

YesNo
Attach your new government issued permit(s) or certificate(s) for every new facility(ies) in New Brunswick where you intend to store Atlantic Used Oil Management Association (New Brunswick) products.*

Attach your file(s)
You can attach more than one file Cancelof
Are you required to produce a report to the government authority having jurisdiction in New Brunswick for your new hazardous waste storage facility(ies) in New Brunswick where you intend to store Atlantic Used Oil Management Association (New Brunswick) products?*

YesNo
Specify which type(s) of report(s), for which facility(ies), and the frequency at which you are required to produce such report(s).*

In the last year, have you aquired or opened any new facility(ies) outside of New Brunswick where you intend to store collected Atlantic Used Oil Management Association (New Brunswick) products?*

YesNo

Please indicate the address of every new hazardous waste storage facility(ies) outside of New Brunswick where you intend to store Atlantic Used Oil Management Association (New Brunswick) products.*
For every new facility(ies) outisde of New Brunswick, briefly explain what are the province or state requirements in order to collect/store the products for which you are registering with Atlantic Used Oil Management Association (New Brunswick).*
Do you have a permit or certificate for your facility(ies) outside of New Brunswick where you store products for which you are registering with Atlantic Used Oil Management Association (New Brunswick)?*

YesNo
Attach your new government issued permit(s) or certificate(s) for every new facility(ies) outside of New Brunswick where you intend to store Atlantic Used Oil Management Association (New Brunswick) products.*

Attach your file(s)
You can attach more than one file Cancelof
Are you required to produce a report to local government authorities for your hazardous waste storage facility(ies) outside of New Brunswick?*

YesNo
Specify which type(s) of report(s), for which facility(ies), and the frequency at which you are required to produce such report(s).*

In the last year, have you shut down operations at any storage facility(ies) located in or out of New Brunswick for products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

Please indicate the address of every hazardous waste storage facility(ies) in or outside of New Brunswick where you ceased operations related to Atlantic Used Oil Management Association (New Brunswick) products and the reason why you stopped.*

In the past year, were any of your installations inspected by the government authority having jurisdiction in New Brunswick (or the equivalent government authority if you are located outside the province of New Brunswick)?*

YesNo
Indicate the address of every inspected facility(ies) and the date of the inspection.*
Over the last year, has your company received an infraction notice from the government authrority having jurisdiction in New Brunswick (or the equivalent government autority if you are located outside of New Brunswick) regarding a storage facility whose activities are related to Atlantic Used Oil Management Association (New Brunswick) products?*

YesNo

Attach a copy of your infraction notice *

Attach your file(s)
You can attach more than one file Cancelof
For each infraction notice your company has received, briefly explain what measures were implemented to correct the situation.*

Please select the zones in which you collect our products*

1 - York, Sunbury, Queens, Kings, St. John, Westmorland2 - Kent3 - Northumberland4 - Carleton, Victoria, Madawaska, Restigouche, Gloucester5 - Albert6 - Charlotte7 - Deer Island, Campobello Island, Grand Manan Island
Civil and environmental insurance certificate.*

Attach your file(s)
You can attach more than one file Cancelof

Please list the address and expiry date of every permit(s)/certificate(s) for facilities where activities are related to the storage of Atlantic Used Oil Management Association (New Brunswick) products. (In or outside of New Brunswick). *
In the last year, have any of your permits been renewed or modified?*

YesNo
Attach every permit renewed or modified within the last year. *

Attach your file(s)
You can attach more than one file Cancelof

In the last year, were you registered with Atlantic Used Oil Management Association (New Brunswick) as a USED OILS collector?*

YesNo

For the upcoming year, would you like USED OILS to remain a product for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

For the upcoming year, would you like to add USED OILS to the list of products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

Have your USED OILS collecting methods remained the same since last year?*

YesNo

On the current form, you mentioned your collecting methods changed in the last year or that you wish to add USED OILS to your list of products as a Atlantic Used Oil Management Association (New Brunswick) collector.

In order to keep your file up to date, you will be required to provide information about the equipment and procedures your company uses to collect USED OILS.
Collection of USED OILS: Estimated annual volume (in litre)*
How long has your company been collecting USED OILS?*
List the address of each facility where you store USED OILS and specify the maximum storage capacity for each facility.*
How many tanks does your company have to store collected USED OILS? Indicate the capacity for each one.*
How many trucks does your company have to collect USED OILS?*
For each of your trucks collecting USED OILS, provide the following information:*
What are the steps of your collection process and how do you keep track of the USED OILS quantities collected at each generators location?*
Do you exercise quality control of the USED OILS collected?*

YesNo
Briefly explain your quality control procedures for the USED OILS collected.*
Are USED OILS analysis performed by an accredited laboratory? (Atlantic Used Oil Management Association (New Brunswick) requires analysis performed by accredited laboratory).*

YesNo
Where do you dispose of oily water?*

On the premisesAt another facility
Indicate the name of the establishment where you dispose of your oily water.*
Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Are you collecting USED OILS applicable to Atlantic Used Oil Management Association (New Brunswick)'s program in other provinces than New-Brunswick?*

YesNo
What control have you implemented in order to determine what qualifies as Atlantic Used Oil Management Association (New Brunswick) and NON-Atlantic Used Oil Management Association (New Brunswick) products amongst the quantities collected?*
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.

In the last year, were you registered with Atlantic Used Oil Management Association (New Brunswick) as a USED ANTIFREEZE collector?*

YesNo

For the upcoming year, would you like USED ANTIFREEZE to remain a product for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

For the upcoming year, would you like to add USED ANTIFREEZE to the list of products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector*

YesNo

Have your USED ANTIFREEZE collecting methods remained the same since last year?*

YesNo

On the current form, you mentioned your collecting methods changed in the last year or that you wish to add USED ANTIFREEZE to your list of products as a Atlantic Used Oil Management Association (New Brunswick) collector.

In order to keep your file up to date, you will be required to provide information about the equipment and procedures your company uses to collect USED ANTIFREEZE.
Collection of USED ANTIFREEZE: Estimated annual volume (in litre)*
How long has your company been collecting USED ANTIFREEZE?*
List the address of each facility where you store USED ANTIFREEZE and specify the maximum storage capacity for each facility.*
How many tanks does your company have to store collected USED ANTIFREEZE? Indicate the capacity for each one.*
How many trucks does your company have to collect USED ANTIFREEZE?*
For each of your trucks collecting USED ANTIFREEZE, provide the following information:*
What are the steps of your collection process and how do you keep track of the USED ANTIFREEZE quantities collected at each generators location?*
Do you exercise quality control of the USED ANTIFREEZE collected?*

YesNo
Briefly explain your quality control procedures for the USED ANTIFREEZE collected.*
Do your truck drivers use a refractometer at every collection?*

YesNo
Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Are you collecting USED ANTIFREEZE applicable to Atlantic Used Oil Management Association (New Brunswick)'s program in other provinces than New-Brunswick?*

YesNo
What control have you implemented in order to determine what qualifies as Atlantic Used Oil Management Association (New Brunswick) and NON-Atlantic Used Oil Management Association (New Brunswick) products amongst the quantities collected?*
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.

In the last year, were you registered with Atlantic Used Oil Management Association (New Brunswick) as a USED FILTERS collector?*

YesNo

For the upcoming year, would you like USED FILTERS to remain a product for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

For the upcoming year, would you like to add USED FILTERS to the list of products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

Have your USED FILTERS collecting methods remained the same since last year?*

YesNo

Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Collection of USED FILTERS: Estimated annual volume (in kg)*
How long has your company been collecting USED FILTERS?*
List the address of each facility where you store USED FILTERS and specify the maximum storage capacity for each facility.*
How many trucks does your company have to collect USED FILTERS?*
For each of your trucks collecting USED FILTERS, provide the following information:*
What are the steps of your collection process and how do you keep track of the USED FILTERS quantities collected at each generators location?*
What type of containers do you collect at your generator's location for USED FILTERS? (select all that applies)*

205L drums240L wheeled bins360L wheeled binsOther
Do you have a scale to weigh the USED FILTERS containers you've collected?*

YesNo
When was your last weighing scale calibration?*
Indicate the date (YYYY-MM-DD)
Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Are you collecting USED FILTERS applicable to Atlantic Used Oil Management Association (New Brunswick)'s program in other provinces than New-Brunswick?*

YesNo
What control have you implemented in order to determine what qualifies as Atlantic Used Oil Management Association (New Brunswick) and NON-Atlantic Used Oil Management Association (New Brunswick) products amongst the quantities collected?*
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.

In the last year, were you registered with Atlantic Used Oil Management Association (New Brunswick) as a USED OIL AND ANTIFREEZE CONTAINERS collector?*

YesNo

For the upcoming year, would you like USED OIL AND ANTIFREEZE CONTAINERS to remain a product for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

For the upcoming year, would you like to add USED OIL AND ANTIFREEZE CONTAINERS to the list of products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

Have your USED OIL AND ANTIFREEZE CONTAINERS collecting methods remained the same since last year?*

YesNo

You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.
Collection of USED OIL AND ANTIFREEZE CONTAINERS: Estimated annual volume (in kg)*
How long has your company been collecting USED OIL AND ANTIFREEZE CONTAINERS?*
List the address of each facility where you store USED OIL AND ANTIFREEZE CONTAINERS and specify the maximum storage capacity for each facility.*
How many trucks does your company have to collect USED OIL AND ANTIFREEZE CONTAINERS?*
For each of your trucks collecting USED OIL AND ANTIFREEZE CONTAINERS, provide the following information:*
What are the steps of your collection process and how do you keep track of the USED OIL AND ANTIFREEZE CONTAINERS quantities collected at each generators location?*
What type of containers do you collect at your generator's location for USED OIL AND ANTIFREEZE CONTAINERS? (select all that applies)*

205L drums240L wheeled bins360L wheeled binsOther
Do you have a scale to weigh the USED OIL AND ANTIFREEZE CONTAINERS containers you've collected?*

YesNo
When was your last weighing scale calibration?*
Indicate la date (YYYY-MM-DD)
Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Are you collecting USED OIL AND ANTIFREEZE CONTAINERS applicable to Atlantic Used Oil Management Association (New Brunswick)'s program in other provinces than New-Brunswick?*

YesNo
What control have you implemented in order to determine what qualifies as Atlantic Used Oil Management Association (New Brunswick) and NON-Atlantic Used Oil Management Association (New Brunswick) products amongst the quantities collected?*
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.

In the last year, were you registered with Atlantic Used Oil Management Association (New Brunswick) as a USED AEROSOL CONTAINERS (lubricants and brake cleaners only) collector?*

YesNo

For the upcoming year, would you like USED AEROSOL CONTAINERS to remain a product for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

For the upcoming year, would you like to add USED AEROSOL CONTAINERS (lubricants and brake cleaners only) to the list of products for which you are registered as a Atlantic Used Oil Management Association (New Brunswick) collector?*

YesNo

Have your USED AEROSOL CONTAINERS (lubricants and brake cleaners only) collecting methods remained the same since last year?*

YesNo

On the current form, you mentioned your collecting methods changed in the last year or that you wish to add USED AEROSOL CONTAINERS to your list of products as a Atlantic Used Oil Management Association (New Brunswick) collector.

In order to keep your file up to date, you will be required to provide information about the equipment and procedures your company uses to collect USED AEROSOL CONTAINERS.
Collection of USED AEROSOL CONTAINERS (lubricants and brake cleaners only): Estimated annual volume (in kg)*
How long has your company been collecting USED AEROSOL CONTAINERS (lubricants and brake cleaners only)?*
List the address of each facility where you store USED AEROSOL CONTAINERS (lubricants and brake cleaners only) and specify the maximum storage capacity for each facility.*
How many trucks does your company have to collect USED AEROSOL CONTAINERS (lubricants and brake cleaners only)*
For each of your trucks collecting USED AEROSOL CONTAINERS (lubricants and brake cleaners only), provide the following information:*
What are the steps of your collection process and how do you keep track of the USED AEROSOL CONTAINERS (lubricants and brake cleaners only) quantities collected at each generators location?*
What type of containers do you collect at your generator's location for USED AEROSOL CONTAINERS (lubricants and brake cleaners only)? (select all that applies)*

205L drum240L wheeled bins360L wheeled binsOther
Do you have a scale to weigh the USED AEROSOL CONTAINERS (lubricants and brake cleaners only) containers you've collected?*

YesNo
When was your last weighing scale calibration?*
Indicate the date (YYYY-MM-DD)
Products applicable to Atlantic Used Oil Management Association (New Brunswick)'s program originating from other provinces are NON-Atlantic Used Oil Management Association (New Brunswick) products.
Are you collecting USED AEROSOL CONTAINERS (lubricants and brake cleaners only) applicable to Atlantic Used Oil Management Association (New Brunswick)'s program in other provinces than New-Brunswick?*

YesNo
What control have you implemented in order to determine what qualifies as Atlantic Used Oil Management Association (New Brunswick) and NON-Atlantic Used Oil Management Association (New Brunswick) products amongst the quantities collected?*
You will need that information in order to complete your collector claim forms and to complete your Atlantic Used Oil Management Association (New Brunswick) annual statement.

What method will you use to proceed with the payment of the registration renewal fee ($200 plus taxes)?*

ChequeElectronic funds transfer (EFT)
Would you like to receive payments by cheque or electronic funds transfer (EFT):*

ChèqueEFT
Do you already receive EFT payments from Atlantic Used Oil Management Association (New Brunswick)?*

YesNo
Please attach a void cheque in order to get EFT*

Attach your file
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Signatory title*
I, {signatoryName}, {signatoryTitle}, declare I am duly authorized for this to complete this form and certify the information provided therein is accurate.
Signature*

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I confirm my signature.
Date*

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