Form CalRecycle851 "Shipping Report - Daily Summary" - California

What Is Form CalRecycle851?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2015;
  • 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 CalRecycle851 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 CalRecycle851 "Shipping Report - Daily Summary" - California

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SHIPPING REPORT –
FOR STATE USE ONLY
TRANSACTION #
DAILY SUMMARY
ATTACHED TO TRANSACTION #
STATE OF CALIFORNIA – CalEPA
DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE)
Division of Recycling
PROCESSOR INVOICE #
CalRecycle 851 (Rev. 11/15)
COMPLETED BY SHIPPER:
RECEIVER INFORMATION
COMPANY
COMPANY
NAME
NAME
ADDRESS
CERT #
MATERIAL
TYPE
AMENDMENT TO TRANSACTION #
REASON FOR AMENDMENT
CERT #
CONTACT
PERSON
TELEPHONE
NUMBER
RECYCLER PAYMENT REQUEST INFORMATION
WEIGHT (LBS) / COUNT
RATE
REFUND
SEGREGATED WEIGHT
COUNT < 24 OZ
COUNT > 24 OZ
FROM Shipping Reports
Receipt & Log Entries For
Thru
TOTAL
Number of Attachments
Total Redemption Weight
RECEIVER PAYMENT ANALYSIS
COMPLETED BY RECEIVER
Weight Ticket #
Received Wt. (LBS)
Refund Value (C)
Processing Payment (D)
Subtotal Due (C+D)
Completed by
Received
ADMINISTRATIVE FEE
% of Reduction Taken
Receiver only
Date
(C X RATE 0.75%)
TOTAL PAYMENT DUE
Civil penalties of up to five thousand dollars ($5,000.00) per day may be
QIP
% OF SHRINKAGE
assessed for violation of the laws and regulations governing this report. In
S or R
addition, the submission of false information with intent to defraud is a crime
punishable by substantial fines, up to three year’s imprisonment, or both.
Knowing this, I certify under penalty of perjury that the facts presented herein
are true and correct to the best of my knowledge.
APPROVED FOR PAYMENT
Shipper’s Signature/Title
Shippers Printed Name
Date
Receiver’s Signature/Title
Receiver’s Printed Name
Date
SHIPPING REPORT –
FOR STATE USE ONLY
TRANSACTION #
DAILY SUMMARY
ATTACHED TO TRANSACTION #
STATE OF CALIFORNIA – CalEPA
DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE)
Division of Recycling
PROCESSOR INVOICE #
CalRecycle 851 (Rev. 11/15)
COMPLETED BY SHIPPER:
RECEIVER INFORMATION
COMPANY
COMPANY
NAME
NAME
ADDRESS
CERT #
MATERIAL
TYPE
AMENDMENT TO TRANSACTION #
REASON FOR AMENDMENT
CERT #
CONTACT
PERSON
TELEPHONE
NUMBER
RECYCLER PAYMENT REQUEST INFORMATION
WEIGHT (LBS) / COUNT
RATE
REFUND
SEGREGATED WEIGHT
COUNT < 24 OZ
COUNT > 24 OZ
FROM Shipping Reports
Receipt & Log Entries For
Thru
TOTAL
Number of Attachments
Total Redemption Weight
RECEIVER PAYMENT ANALYSIS
COMPLETED BY RECEIVER
Weight Ticket #
Received Wt. (LBS)
Refund Value (C)
Processing Payment (D)
Subtotal Due (C+D)
Completed by
Received
ADMINISTRATIVE FEE
% of Reduction Taken
Receiver only
Date
(C X RATE 0.75%)
TOTAL PAYMENT DUE
Civil penalties of up to five thousand dollars ($5,000.00) per day may be
QIP
% OF SHRINKAGE
assessed for violation of the laws and regulations governing this report. In
S or R
addition, the submission of false information with intent to defraud is a crime
punishable by substantial fines, up to three year’s imprisonment, or both.
Knowing this, I certify under penalty of perjury that the facts presented herein
are true and correct to the best of my knowledge.
APPROVED FOR PAYMENT
Shipper’s Signature/Title
Shippers Printed Name
Date
Receiver’s Signature/Title
Receiver’s Printed Name
Date