Form CalRecycle910-PMD2 "Plastic Market Development Payment Claim Form" - California

What Is Form CalRecycle910-PMD2?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CalRecycle910-PMD2 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle910-PMD2 "Plastic Market Development Payment Claim Form" - California

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State of California - Department of Resources Recycling and Recovery (CalRecycle)
Division of Recycling
801 K Street, MS 17-24 • Sacramento, California 95814
Phone 916/323-5778 • Fax 916/445-0645 • TDD 916/324-2555
http://www.calrecycle.ca.gov/
CalRecycle 910-PMD2
(Rev. 2/18)
Plastic Market Development Payment Claim Form
st
nd
rd
th
Application for Calendar Quarter (check one):
1
2
3
4
Year:
Certification/Identification Number:
Facility Name:
Mailing Address:
Contact Person:
Telephone Number:
Type of Material:
Flake
Pellet
Other:
Weight of Material Shipped (Tenth of Tons, include decimal point)
#1 PET:
#2 HDPE:
#3 PVC:
#4 LDPE:
#5 PP:
#6 PS:
#7 Other:
(check one)
As a certified entity, I certify under penalty of perjury that the plastic materials herein were
sold to a California product manufacturer.
As a California product manufacturer, I certify under penalty of perjury that the plastic
product(s) identified below was made in California from plastic purchased from a certified
entity in California:
I certify under penalty of perjury that the facts presented herein are true and correct to the best of my knowledge
Signature and Title of Authorized Representative:
Date:
Clear
Print
State of California - Department of Resources Recycling and Recovery (CalRecycle)
Division of Recycling
801 K Street, MS 17-24 • Sacramento, California 95814
Phone 916/323-5778 • Fax 916/445-0645 • TDD 916/324-2555
http://www.calrecycle.ca.gov/
CalRecycle 910-PMD2
(Rev. 2/18)
Plastic Market Development Payment Claim Form
st
nd
rd
th
Application for Calendar Quarter (check one):
1
2
3
4
Year:
Certification/Identification Number:
Facility Name:
Mailing Address:
Contact Person:
Telephone Number:
Type of Material:
Flake
Pellet
Other:
Weight of Material Shipped (Tenth of Tons, include decimal point)
#1 PET:
#2 HDPE:
#3 PVC:
#4 LDPE:
#5 PP:
#6 PS:
#7 Other:
(check one)
As a certified entity, I certify under penalty of perjury that the plastic materials herein were
sold to a California product manufacturer.
As a California product manufacturer, I certify under penalty of perjury that the plastic
product(s) identified below was made in California from plastic purchased from a certified
entity in California:
I certify under penalty of perjury that the facts presented herein are true and correct to the best of my knowledge
Signature and Title of Authorized Representative:
Date: