New Brunswick-Collectors annual statement

UOMA New Brunswick - Collectors annual statement
Statement for the year
UOMA NB # *
Company legal name *

Address *

Street Address
Street Address (line 2)
Municipality	Province/State
Postal/Zip Code	pays

Telephone *

Area Code Phone #
Extension

Amongst the following products, which one(s) were you registered for as a UOMA NB collector? *

Used oils Used glycols (antifreezes) Used filters Used oil and glycol (antifreeze) containers Used aerosol containers

Used oils

Please indicate the used oil quantities your company had in inventory on the dates below for the year which the statement is in regards to. *

	January 1st	December 31st
Quantity (L)

Quantity of UOMA NB used oils collected over the last year (in liters) *
Total quantity of used oils collected over the last year (in liters) *

Used glycols (antifreezes)

Please indicate the used glycol (antifreeze) quantities your company had in inventory on the dates below for the year which the statement is in regards to. *

	January 1st	December 31st
Quantity (L)

Quantity of UOMA NB used glycols (antifreezes) collected over the last year (in liters) *
Total quantity of used glycols (antifreezes) collected over the last year (in liters) *

Used filters

Please indicate the used filters quantities your company had in inventory at the dates below for the year which the statement is in regards to. *

	January 1st	December 31st
Quantity (kg)

Quantity of UOMA NB used filters collected over the last year (in kg) *
Total quantity of used filters collected over the last year (in kg) *

Used oil and glycol (antifreeze) containers

Please indicate the used oil and glycol (antifreeze) containers quantities your company had in inventory on the dates below for the year which the statement is in regards to. *

	January 1st	December 31st
Quantity (kg)

Quantity of UOMA NB used oil and glycol (antifreeze) containers collected over the last year (in kg) *
Total quantity of used oil and glycol (antifreeze) containers collected over the last year (in kg) *

Used aerosol containers

Please indicate the used aerosol containers quantities your company had in inventory on the dates below for the year which the statment is in regards to. *

	January 1st	December 31st
Quantity (kg)

Quantity of UOMA NB used aerosol containers collected over the last year (in kg) *
Total quantity of used aerosol containers collected over the last year (in kg) *

Signatory name *
Signatory title *
Email address *
I, {signatoryName}, {typeA} 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.
Signature *

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*

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Date *

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UOMA New Brunswick - Collectors annual statement