Collector Reporting Form Program Year 2 by ronny19938

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									Minnesota Electronics Recycling Act                                                                                                w-gen2-60
Collector Reporting Form: Program Year 2 (July 1, 2008 - June 30, 2009)
A. Contact
Information                Collector Data                                                        FORM INSTRUCTIONS:
Company Name
MN Tax ID                                                                                        Click on "Instructions" tab in this
Phone                                                                                            workbook.
E-Mail
Contact Person



B. Collected Covered Electronic Devices
Enter actual pounds of CED collected. (DO NOT include the 1.5 factor for counties outside the 11-county Metro Area: Anoka, Carver,
Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington and Wright.)
Total pounds collected
inside the 11-county   Total pounds collected outside the
metro area *           11-county metro area*                                                    Source of Pounds

                                                              1. Special Events (collection events, city/county cleanups, Earth Day etc.)

                                                              2. Regular Physical Collection Location (registered permanent sites)

                                                              3. Mail Back

                                                              4. Incidental (litter, waste facilities)

                                                              5. Other source (please state source):

                                                              6. Pickup Service

                                                              7. Curbside Recycling Collection Program

                                                              8. Unknown
                       0                                    0 Subtotals

                                                            0 Total pounds collected
                                                            0 Total with 1.5 Factor




w-gen2-60 (June 2009) v. 2
C. Recyclers Used
Enter actual pounds of CED recycled. (DO NOT include the 1.5 factor for counties outside the 11-county Metro Area: Anoka, Carver,
Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington and Wright.)
1. Recycler                2. Other                                  3. Pounds sent                4. Pounds sold

                           If not to a recycler, the name of
                           entity other than a recycler where        Actual pounds sent to
Recyclers used; Use        pounds were sent. (e.g. another           entity named in column Name of the entity that you sold these pounds
the drop-down list.        collector)                                1 or 2.                to. If not sold leave blank.




                                                                                                  0 Must match "Total pounds collected" (Part B)
To add rows, right click on the row numbers inside the table and select "insert"

D. Certification

I certify that the total weight of Covered Electronic Devices documented on this form is true
and correct in compliance with the Minnesota Electronics Recycling Act. I also certify that all
facilities where items were sent for recycling were registered with the MPCA.
Name

Re-enter your MN tax ID number as your electronic signature.
MN Tax ID #
Date




w-gen2-60 (June 2009) v. 2
                                              Recycler List


                 CompanyName                OrganizationID   OrgTypeID
5R Processors Ltd                                   1430 Recycler
Asset Recovery Corporation                          1218 Collector and Recycler
Avista Recycling Inc                                1438 Recycler
B.C.S. Recycling Specialists                        1241 Collector and Recycler
Balcum Appliance, Inc.                              1261 Collector and Recycler
Brian Matthew Hauer Enterprises                     1259 Collector and Recycler
Burg Electronic Recovery, Inc.                      1250 Collector and Recycler
Cascade Asset Management, LLC                       1426 Recycler
Certified Recycling                                 1234 Collector and Recycler
Computer & Electronic Disposal Co.                  1256 Collector and Recycler
Computer Eaters LLC                                 1249 Collector and Recycler
CRT Processing, LLC                                 1229 Collector and Recycler
D&S Copier Sales/E-Cycling                          1224 Collector and Recycler
Dynamic Recycling                                   1231 Collector and Recycler
E Cycling Solutions                                 1239 Collector and Recycler
Earth First Computer Recycling and Resources, Inc.  1253 Collector and Recycler
Enviro-Chem, Inc.                                   1236 Collector and Recycler
Evergreen Recycling LLC                             1448 Recycler
Ferraro Metal Recycling                             1446 Recycler
First Choice Computer Recycling                     1255 Collector and Recycler
Freeport Recycling Center                           1252 Collector and Recycler
Green Lights Recycling, Inc.                        1217 Collector and Recycler
Groth Enterprises                                   1230 Collector and Recycler
Guaranteed Recycling Xperts                         1441 Recycler
HighPoint Environmental LLC                         1443 Recycler
Hove Enterprises Inc. DBA Hove Metals               1223 Collector and Recycler
Intechra LLC                                        1251 Recycler
Integrated Recycling Technologies                   1242 Collector and Recycler
Interco Trading Company                             1436 Recycler
Intercon Solutions                                  1431 Recycler
Jack's Family Recycling Center                      1233 Collector and Recycler
JCT 81 Enterprises                                  1228 Collector and Recycler
John's Twin Ports Recycling                         1237 Collector and Recycler
Lifecyclers Electronics Recycling                   1219 Collector and Recycler
Mark's Recycling                                    1247 Collector and Recycler
Materials Processing Corporation                    1221 Collector and Recycler
Metech International                                1243 Collector and Recycler
Metro Appliance Recycling                           1260 Collector and Recycler
Midwest Computer Recyclers LLC                      1222 Collector and Recycler
Millennium Recycling Inc                            1437 Recycler
Ocean Enterprises                                   1235 Collector and Recycler
Olmsted County Public Works                         1226 Collector and Recycler
re.Source Partners Asset Management, Inc.           1434 Recycler
Recycle Technologies, Inc.                          1220 Collector and Recycler
Recycling Management Solutions                      1244 Collector and Recycler
Redemtech Inc                                       1444 Recycler
S.W. Recycling                                      1227 Collector and Recycler
Salisbury Electronic Recycling                      1262 Collector and Recycler
Scientific Recycling, Inc.                          1429 Recycler
Sims Recycling Solutions                            1442 Recycler
SRC, Inc.                                           1254 Collector and Recycler


                                                 Page 3
                                     Recycler List


Supply-Chain Services, Inc.               1225   Collector and Recycler
Synapse, LLC                              1440   Recycler
Tennis Sanitation LLC                     1246   Collector and Recycler
TRF Computers                             1248   Collector and Recycler
Trinity Electronics LLC                   1447   Recycler
Veolia ES Technical Solutions, LLC        1445   Recycler
WF Industries, Inc.                       1257   Collector and Recycler
WM Recycle America, LLC                   1425   Recycler




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CompanyName                             OrganizationID   OrgTypeID
1-800-GOT-JUNK?                                   1295   Collector
5R Processors Ltd.                                1336   Collector
A to Z Recycle                                    1351   Collector
Ace Solid Waste                                   1311   Collector
Advanced Recyclers                                1232   Collector
Allied Waste Services, Inc.                       1272   Collector
Andrew Knutson, Inc. dba 1-800-GOT-JUNK?          1327   Collector
Asset Recovery Corporation                        1218   Collector and Recycler
Audio Video Planners, Inc.                        1271   Collector
Avista Recycling Inc.                             1390   Collector
B.C.S. Recycling Specialists                      1241   Collector and Recycler
Balcum Appliance, Inc.                            1261   Collector and Recycler
Becker County Environmental Services              1308   Collector
Belretech                                         1400   Collector
Best Buy                                          1275   Collector
Big Stone County                                  1423   Collector
Blue Earth County Environmental Services          1333   Collector
Brian Matthew Hauer Enterprises                   1259   Collector and Recycler
Buberl Recycling & Composting, Inc.               1286   Collector
Buckingham Companies                              1287   Collector
Burg Electronic Recovery, Inc.                    1250   Collector and Recycler
BYTE, Incorporated                                1379   Collector
Carlton County Transfer Station                   1273   Collector
Carver County Environmental Services              1312   Collector
Cass County                                       1371   Collector
Certified Recycling                               1234   Collector and Recycler
Chisago Metal Recycling                           1348   Collector
City of Albert Lea                                1397   Collector
City of Andover                                   1298   Collector
City of Anoka                                     1281   Collector
City of Brooklyn Center                           1369   Collector
City of Brooklyn Park                             1367   Collector
City of Coon Rapids                               1377   Collector
City of Crystal                                   1370   Collector
City of Golden Valley                             1338   Collector
City of Hopkins                                   1292   Collector
City of Maple Grove                               1324   Collector
City of Minneapolis                               1285   Collector
City of Minnetonka                                1302   Collector
City of Mound                                     1349   Collector
City of New Hope                                  1368   Collector
City of North Mankato                             1339   Collector
City of North Saint Paul                          1301   Collector
City of Nowthen                                   1406   Collector
City of Plymouth                                  1408   Collector
City of Roseville                                 1358   Collector
Clay County Solid Waste                           1413   Collector
Commercial E-Waste Management, Inc.               1356   Collector
Computer & Electronic Disposal Co.                1256   Collector and Recycler
Computer Eaters LLC                               1249   Collector and Recycler
Cottonwood County Solid Waste Dept.               1313   Collector
Crow Wing County Solid Waste                      1346   Collector
CRT Processing, LLC                               1229   Collector and Recycler
D&S Copier Sales/E-Cycling                        1224   Collector and Recycler
Dell, Inc.                                           1393   Collector
Dem-Con Companies, LLC                               1420   Collector
Dick's Sanitation/Lakeville Sanitary                 1345   Collector
Dodge County Environmental Quality                   1372   Collector
DSI Distributing dba DSI Systems                     1414   Collector
Dynamic Recycling                                    1231   Collector and Recycler
E Cycling Solutions                                  1239   Collector and Recycler
E Pick Up                                            1419   Collector
Eagle Appliance Recycling                            1385   Collector
Earth First Computer Recycling and Resources, Inc.   1253   Collector and Recycler
East Central Solid Waste Commission                  1264   Collector
Ecycle IT, Inc.                                      1362   Collector
Engaged Recycling, LLC                               1424   Collector
Engebretson Disposal                                 1265   Collector
Enviro-Chem, Inc.                                    1236   Collector and Recycler
eRecycleZone                                         1410   Collector
Evergreen Recycling                                  1274   Collector
Ewaste Recyclers                                     1280   Collector
Ewaste Solutions                                     1304   Collector
Expetec of Blaine                                    1404   Collector
Faribault County                                     1361   Collector
Fillmore County                                      1305   Collector
First Choice Computer Recycling                      1255   Collector and Recycler
Freeport Recycling Center                            1252   Collector and Recycler
Garrison Disposal                                    1266   Collector
Gibson Sanitation LLC                                1306   Collector
Glacier Ridge Computing                              1409   Collector
Goodhue County Public Works                          1350   Collector
Goodnews Computer Recycler                           1328   Collector
Gopher Resource Corporation                          1398   Collector
Grant County Solid Waste                             1381   Collector
Green Lights Recycling, Inc.                         1217   Collector and Recycler
Greystone Data Systems, Inc                          1389   Collector
Groth Enterprises                                    1230   Collector and Recycler
Hartel's / DBJ Disposal Companies                    1407   Collector
Hennepin County Environmental Services               1365   Collector
Hewlett Packard                                      1396   Collector
Horak Inc. dba River City Services                   1322   Collector
Houston County Environmental Services                1263   Collector
Hove Enterprises Inc. DBA Hove Metals                1223   Collector and Recycler
Hubbard County Recycling (D.A.C.)                    1388   Collector
Integrated Recycling Technologies                    1242   Collector and Recycler
Itasca County Environmental Services                 1297   Collector
Jack's Family Recycling Center                       1233   Collector and Recycler
Jackson County                                       1359   Collector
JCT 81 Enterprises                                   1228   Collector and Recycler
Johnny's TV                                          1415   Collector
John's Sanitary Removal                              1417   Collector
John's Twin Ports Recycling                          1237   Collector and Recycler
KA Nash Company                                      1380   Collector
Kandiyohi County Environmental Services              1284   Collector
Koochiching County Environmental Services            1418   Collector
Lac qui Parle County Environmental Services          1283   Collector
Lake of the Woods County                             1316   Collector
Lakes Sanitary                                       1451   Collector
Lexmark International                      1450   Collector
Lifecyclers Electronics Recycling          1219   Collector and Recycler
Lincoln County Environmental               1382   Collector
LJP Enterprises of St. Peter LLC           1374   Collector
LJP Enterprises Waste & Recycling LLC      1375   Collector
Luminaire Recyclers Inc.                   1296   Collector
Lyon County                                1319   Collector
Magnuson Trucking & Leasing, Inc.          1270   Collector
Mar-Kit Landfill                           1340   Collector
Mark's Recycling                           1247   Collector and Recycler
Martin County                              1360   Collector
Materials Processing Corporation           1221   Collector and Recycler
McLeod County Solid Waste Management       1321   Collector
Mercury Technologies of Minnesota, Inc.    1320   Collector
Metech International                       1243   Collector and Recycler
Metro Appliance Recycling                  1260   Collector and Recycler
Micro Center Sales Corporation             1299   Collector
Midwest Computer Recyclers LLC             1222   Collector and Recycler
Millennium Recycling, Inc.                 1342   Collector
Minnesota Waste Processing Company         1376   Collector
Morrison County Public Works               1331   Collector
Murray County                              1278   Collector
Nobles County Environmental Services       1330   Collector
Norman County Demolition Landfill          1307   Collector
Ocean Enterprises                          1235   Collector and Recycler
Office Depot                               1353   Collector
Olmsted County Public Works                1226   Collector and Recycler
Otter Tail County Solid Waste Department   1300   Collector
Pennington County                          1355   Collector
Pipestone County                           1332   Collector
Plaza TV & Appliance, Inc.                 1357   Collector
Polk County Environmental Services         1383   Collector
R&S Appliance Recycling                    1366   Collector
Randy's Sanitation, Inc.                   1334   Collector
Recycle Technologies, Inc.                 1220   Collector and Recycler
Recycling For Wildlife                     1323   Collector
Redwood County Environmental Office        1363   Collector
Renville County                            1364   Collector
Resource Recovery Technologies             1395   Collector
Rice County Solid Waste Department         1294   Collector
Robert Paul Company Inc.                   1416   Collector
Rock County Highway Department             1402   Collector
Roseau County Environmental Office         1354   Collector
S.W. Recycling                             1227   Collector and Recycler
Salisbury Electronic Recycling             1262   Collector and Recycler
Schwartzman Co. Div. of Alter Trading      1412   Collector
Scott County                               1279   Collector
SRC, Inc.                                  1254   Collector and Recycler
St. Louis County Environmental Services    1405   Collector
Steele County Environmental Services       1267   Collector
Stockman Transfer, Inc.                    1310   Collector
Sunrise Farm Corp of Montgomery            1276   Collector
Supply-Chain Services, Inc.                1225   Collector and Recycler
Swift County Environmental Services        1293   Collector
Tennis Sanitation LLC                      1246   Collector and Recycler
The Retrofit Companies, Inc.                 1314   Collector
Todd County Department of Solid Waste        1289   Collector
TRF Computers                                1248   Collector and Recycler
Tri County Solid Waste                       1291   Collector
Trinity Electronics, LLC                     1411   Collector
Tri-Star Recycling, Inc.                     1386   Collector
Twin City Refuse & Recycling                 1325   Collector
United Cerebral Palsy of Central Minnesota   1344   Collector
Veolia ES - Vasko Solid Waste                1329   Collector
Wadena County Solid Waste                    1378   Collector
Walters Recycling and Refuse                 1391   Collector
Waseca County Solid Waste                    1352   Collector
Washington County                            1392   Collector
Waste Management of Bemidji                  1421   Collector
Waste Management of Minnesota                1403   Collector
Watonwan County Public Works Department      1401   Collector
Weiske Enterprises                           1394   Collector
Western Lake Superior Sanitary District      1277   Collector
WF Industries, Inc.                          1257   Collector and Recycler
WM LampTracker                               1422   Collector
Wm. Miller Scrap Iron & Metal Co.            1343   Collector
Wright County Solid Waste                    1384   Collector
Reports are due July 15. 2009

E-mail completed forms as an attachment to electronics@pca.state.mn.us
For assistance. Call Andy Ronchak at 651-558-6157 or 800-657-3864 toll free, or e-mail Andrew.ronchak@pca.stat

Reporting Guidance for Collectors
Please read this entire document before filing a report.

Buying, selling, and credits
If you are a collector that paid for electronics recycling and were subsequently paid by a manufacturer or other comp
those transactions. Please make sure that the collected pounds are reported only once on this form, and only by ONE
manufacturer’s recycling credits back to the source of the pounds.

Reporting collection from multiple sites
If multiple collection sites are all registered to one collector, the collector can use a single form for all of the sites.

Example: Acme E-Collection Co. collects electronics at several Acme-registered collection locations around the state
sites can be consolidated onto a single reporting form.

Example: Acme County is a registered collector and has registered its two HHW sites as collection sites. Both of tho

If a collector serves collection sites that are registered to other collectors, there must be a separate form for the data fr

Example: Acme Recycling has collected electronics from several city collection events. The cities have registered wi
Recycling can fill out a separate form for each city ONLY if that if that registered city has not reported those collecte

Unregistered recycler
All covered electronic devices must be recycled by electronics recyclers that have registered with the MPCA. If the r
the MPCA for assistance: Call Andy Ronchak at 651-558-6157 or 800-657-3864 toll free, or e-mail Andrew.ronchak

Filling out the reporting form

About the form. The Microsoft Excel worksheet ("Collection Reporting sheet" tab) is designed to be filled in and re
attachment. The form does contain formulas and macros; the macros will not harm your computer, so please enable t
security settings in MS Excel. Some cells in the form are locked for ease of data entry.

Contact Information
Company name and contact information for the person filling out this form. Your Minnesota Tax ID number is for tr
Agency has the correct company as many names are similar.

B. Collected Covered Electronic Devices
This section is for reporting the pounds of collected covered electronic devices (CED).

Collectors can report only collected covered electronic devices (CED), which have to come from households in Minn
facsimile machines (fax), DVD players, video cassette recorders (VCR), and “video display devices” (televisions or c
computers, that contain a cathode-ray tube or a flat panel screen with a screen size that is greater than nine inches me
by manufacturers for use by households).

1) Metro Pounds. Pounds of CEDs you collected from the 11-county Metro Area: Anoka, Carver, Chisago, Dakota,
Sherburne, Washington and Wright.
Sherburne, Washington and Wright.

2) Non-Metro Pounds. Actual pounds of CEDs you collected from outside the 11-county Metro Area. (Use actual w

3) Source of pounds.

Special Events include short collection events, city cleanup days, Earth Day, or other events that you have held.

Regular Physical Collection Location covers your registered permanent sites

Mail Back covers those services that receive CEDs through the mail.

Incidental includes litter cleanups, roadside dumping of household products, and items taken from tipping floors. If
location it is not necessary to break out your pounds into this category if they were not already tracked this way. (For
site at a transfer station that occasionally gets an item from the tipping floor.)

Other Source: Please list the source.

Pickup Service hauls away CEDs from a household location as a special service.

Curbside Recycling Collection Program is offered as part of household recycling service.

Unknown: Source of the CEDs is not known.

C. Recyclers Used
This section is for reporting the destinations of your pounds of collected CEDs.

1) Recycler. Select using the drop-down menu. If the recycler you used is not listed, contact the MPCA for assistanc
6157 or 800-657-3864 toll free, or e-mail Andrew.ronchak@pca.state.mn.us.

2) Other. If not a recycler, name the entity that received your collected pounds.

3) Pounds Sent. Pounds of CEDs sent to a “recycler” or “other.” Use a separate line for each destination, adding line

4) Pounds Sold. Name the purchasing company or organization or the category (e.g., manufacturer, recycler). If coll
blank.

D. Certification
Confirmation of the accuracy of information provided on this form, in compliance with the Minnesota Electronics Re
used as an electronic signature.
drew.ronchak@pca.state.mn.us.




 facturer or other company, please provide information about
orm, and only by ONE collector. This will help us track



m for all of the sites.

 cations around the state. Data from all of Acme’s registered


 ction sites. Both of those sites can be reported on one form.

rate form for the data fr om each registered collector.

 ities have registered with the MP CA as collectors. Acme
  reported those collected po unds on its own.


with the MPCA. If the recycler you used is not listed, contact
       Andrew.ronchak@pca.state.mn.us.



ed to be filled in and returned to the MPCA via e-mail as an
uter, so please enable them. You may need to adjust the



Tax ID number is for tracking purposes to ensure that the




om households in Minnesota: Computers, peripherals,
evices” (televisions or computer m onitors, including laptop
 er than nine inches measured diagonally and are marketed


 rver, Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott,
tro Area. (Use actual weight; do not apply the 1.5 factor.)



hat you have held.




from tipping floors. If you are a regular physical collection
 tracked this way. (For example, a regular e-waste collection




he MPCA for assistance: Call Andy Ronchak at 651-558-




destination, adding lines if necessary.

cturer, recycler). If collector did not sell these pounds, leave



innesota Electronics Recycling Act. Minnesota Tax ID is

								
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