Household Hazardous Waste Participant FormHousehold Hazardous Waste Reporting"*" indicates required fieldsLocation*select LocationHoldregeKearneyNorth PlattePhone*Name of Person Reporting* First Last Quarterly Period*January-MarchApril-JuneJuly-SeptemberOctober-Decemberselect oneLbs of latex paint collected:* Conversions: 55 gal. barrel of paint weighs approx. 500 lbs. or use 10 lbs. per full can of paint-you may want to figure 10 lbs. per every two to three non-full cans of paintLbs of all other materials collected:*Conversions: 55 gal. drum holds about 300 lbs. of hazardous chemicals and a pallet holds 4 drums on average for 1200 lbs. per palletWeight of Materials Collected:Please fill in 0 if not applicable.household cleaners*Household CleanersInsecticides, Pesticides, etc*Insecticides, Pesticides, etcOil-based Paint*Oil-based PaintAerosol Paint*Aerosol PaintAerosols*AerosolsFertilizer*FertilizerAcids (Drainer Opener, etc.)*Acids (Drainer Opener, etc.)Batteries*BatteriesAutomotive*AutomotiveMiscellaneous Chemicals*Miscellaneous ChemicalsFluorescent Bulbs*Fluorescent BulbsElectronics*ElectronicsIf you run a Swap Section at your facility, please provide an estimate of the quantity claimed by othersCAPTCHA
