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
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 (lubricants and brake cleaners only)

Used oils

Please indicate below the quantity of used oil your company had in inventory on the dates shown for the statement year. *

	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 below the quantity of used glycol (antifreeze) your company had in inventory on the dates shown for the statement year. *

	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 below the quantity of used filters your company had in inventory on the dates shown for the statement year. *

	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 below the quantity of used oil and gycol (antifreeze) containers your company had in inventory on the dates shown for the statement year. *

	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 (lubricants and brake cleaners only)

Please indicate below the quantity of used aerosol containers (lubricants and brake cleaners only) your company had in inventory on the dates shown for the statement year. *

	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 *

Clear
*

I confirm my signature
Date *

Month Day Year
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UOMA New Brunswick - Collectors annual statement