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ACT 101 RECYCLING COMPLIANCE REPORT INSTRUCTIONS CHECKLIST

  1. This form is to be completed by commercial, municipal or institutional establishments in PA
    Commercial Establishment: An establishment engaged in non-manufacturing or non-processing business, including, but not limited to, stores, markets, office buildings, medical offices, restaurants, shopping centers and theaters.

    Municipal Establishment: An establishment engaged in government work including, but not limited to, offices of the federal government, state government, cities, boroughs, incorporated towns, townships, counties and authorities.

    Institutional Establishment: An establishment engaged in service including, but not limited to, hospitals, nursing homes, orphanages, schools and universities.

    The information on this form will be used by the municipality where you are located to gauge your compliance with their recycling ordinance (if they have one) and to complete a recycling performance grant. The materials listed on the first page may be required by local ordinance to be recycled and, with the exception of the organics, can be used for the municipal recycling performance grant. The materials listed on the second page are common materials recycled, but they are not usually required to be recycled by local ordinance and cannot be used for the municipal recycling performance grant.

    Please complete this report on or before March 8th, 2021.
  2. Please use the following checklist to complete form FM-11:
  3. You must attach a legible weight ticket from your recycler for any materials recycled on page 1
    **ENTER the GROSS WEIGHT of all material. DO NOT subtract processing residue before entering your tonnages on this form. Processing residue is material that is collected and weighed with recyclables, but is disposed rather than recycled. PA DEP has a formula it will use to subtract processing residue.

    DO NOT REPORT PROCESSING RESIDUES ON THIS FORM.

    If you deliver your materials commingled or single stream, please check the appropriate boxes to note the recyclable materials in the mix, but only enter the tonnage beside commingled or single stream. Do not estimate tonnages of each individual recyclable material in the commingled or single stream mix.
  4. Use this conversion chart as necessary
    Antifreeze: 7.2 lbs per gallon

    Battery – Lead Acid:
    Car = 17.8 lbs
    Truck = 48.7 lbs
    Motorcycle = 8.7 lbs

    Rubber Tires:
    Car = 21 lbs
    Truck = 70 lbs

    Used Oil: 7.2 lbs per gallon

    Oil Filters: 1.2 lbs each

    Glass – Whole Bottle: 1 ton = 2 yds3

    Newsprint – Loose: 1 ton = 3 yds3

    Corrugated Cardboard: 2.5’ x 4’ x 5’ bale = 1100 lbs

    Plastic Soda Bottles
    Whole, Loose: 30 lbs = 1 yd3

    Plastic Film: 2.5’ x 4’ x 5’ bale = 1500 lbs

    Solid & Liquid Fats: 55 gallon drum = 412 lbs

    White Goods
    Freezers: 1 = 250 lbs
    Refrigerators: 1 = 250 lbs
    Other Appliances: 1 = 150 lbs

    Yard Waste
    Leaves: 4 yd3 = 1 ton
    Grass Clippings: 2 yd3 = 1 ton
    Wood Chips: 1 yd3 = 500 lbs
  5. Form FM-11. REV. 10/27/20
  6. ACT 101 RECYCLING COMPLIANCE REPORT
    For Commercial, Municipal, Institutional Facilities
  7. BERKS COUNTY
  8. MUHLENBERG TOWNSHIP
  9. How does your establishment handle recyclable materials?
  10. If you choose one of the three options below and provided the name of collector, submit now.
  11. Please provide name or location for the option above
  12. If you choose one of the three options below and provided the name of collector, complete form below.
  13. Please provide name or location for the option above
  14. 1. CHECK the box in front of each pre-consumer* material that your establishment recycled.
  15. 2. Enter the weight in tons and attach a legible weight ticket from your recycler. Enter the GROSS WEIGHT**. DO NOT subtract any processing residue.
  16. 3. CHECK the box in front of each pre-consumer material recycled at your establishment.
  17. 4. If you market the recyclables yourself, enter the weight (in tons) of material recycled.
  18. 5. If you use a commingled or single stream collection system, check the boxes beside each material in the mix.
  19. Material Type
    (all recyclables, including fiber, collected together)
  20. Material Type
    (two or more materials collected together, fiber separate)
  21. Glass Bottles and Jars
  22. Paper
  23. Plastics
  24. Metals
  25. **Enter GROSS WEIGHT of all material. DO NOT subtract any processing residue as PA DEP has a formula it will apply
  26. Household / Commercial Hazardous Waste
  27. Other Recyclables
  28. Organics
  29. I certify, to the best of my knowledge, that the information on this form is complete and accurate. I further authorize the Municipality to aggregate this report for DEP reporting purposes. If a legible weight ticket is attached, this report may also be used for DEP grant purposes.
  30. If you have more than one file, you can e-mail them directly to Jim Bobeck at jbobeck@muhlenbergtwp.com
  31. Leave This Blank:

  32. This field is not part of the form submission.