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OSE 8. FORM OF MATERIAL: (CHECK ONE) YES 3. WILL THE MATERIAL BE SOLD IN CA FOR CA REFUND VALUE (CRV)? (Loads weighing 100 lbs. or more require a weight ticket issued by a certified weighmaster) LDPE #4 (LOW DENSITY POLYETHYLENE) NO 5. ESTIMATE THE PERCENTAGE OF DECLARED MATERIAL THAT IS EMPTY BEVERAGE CONTAINERS: 6. HOW WAS THE REPORTED WEIGHT DETERMINED? (CHECK ONE) 7. MATERIAL TYPE: (CHECK ONE) YES ) PREPARER S SIGNATURE: X ) MONTH 10. SIGNATURE DATE: DAY YEAR.

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