MARYLAND DEPARTMENT OF THE ENVIRONMENT
[Pages:4]MARYLAND DEPARTMENT OF THE ENVIRONMENT
Land Management Administration ? Waste Diversion and Utilization Program 1800 Washington Boulevard, Suite 610 ? Baltimore, Maryland 21230-1719 410-537-3314 ? 800-633-6101 x3314 ?
FORM A ? Publisher's Report
Maryland Recycling Act (MRA) Telephone Directory Tonnage Report
All publishers who distribute telephone directories in Maryland must complete Form A ? Publisher's Report and return it to the Maryland Department of the Environment. For the purposes of this report, a directory publisher means a person engaged in publishing telephone directories of any kind as part of its business that: in the previous calendar year used at least 50 tons of directory stock in telephone directories that were distributed in the State; or anticipates using, in the current calendar year, at least 50 tons of directory stock in telephone directories that are distributed in the State. (Annotated Code of Maryland, Environment Article ? 9-1709 Telephone Directory Recycling by Directory Publishers).
General Information
Name of Publisher:
Contact Name & Title:
Telephone No.:
Extension:
Fax No.:
Email:
Company Address:
Reporting Period
Year:
Publications
List all telephone directories published by your company and distributed in Maryland. Attach additional sheets if necessary.
Form Number: MDE/WAS/COM.020 Revision Date: 6-Jul-12 TTY Users 800-735-2258
Page 1 of 4
Publications continued . . .
Form Number: MDE/WAS/COM.020 Revision Date: 6-Jul-12 TTY Users 800-735-2258
Page 2 of 4
Statistical Data Attach additional sheets if needed.
(A) Printer
Name of Printer
(C) Tons of
(B) Tons of
Recycled
Directory Stock Directory Stock
(from Form B, (from Form B,
total Column R) total Column S)
315.3
94.6
(D) Recycled Content %
(in decimal)
(C ? B)
0.30
(E) Tons of (F) Tons of (G) Tons of
Directory Stock Directory Stock Recycled
Distributed Distributed in Directory Stock
Outside of
Maryland Distributed in
Maryland
(B - E)
MD (D x F)
50
265.3
79.6
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
TOTALS
* Must be in tons (i.e., ton = short ton = 2,000 lbs.). If raw data is in metric tons, convert to tons by multiplying the raw data metric ton total by "1.102" before entering it in the table.
Form Number: MDE/WAS/COM.020 Revision Date: 6-Jul-12 TTY Users 800-735-2258
Page 3 of 4
(H) Total Tons of Directory Stock Distributed in Maryland (F in Table):
(I) Target Recycled Directory Stock Tonnage (H x 0.4):
(J) Total Tons of Recycled Directory Stock Distributed in Maryland (G in Table):
(K) Recycling Content Percentage:
J H
?100
=
__________ ______
(L) Subtract (J) from (I). If (J) is more than (I), enter "0":
(M) Amount you owe for Recycling Incentive Fee (L x $10):
Payment should be in the form of a check made payable to "Maryland Department of the Environment". Please write "PCA 13717 / OBJECT 5671" on the note line of your check and attach a copy of Form A.
I hereby attest that the information provided in this Publisher's Report is accurate and complete.
/
Signature
Title
/ Date
NO PAYMENT DUE: Send the original completed Form A to:
Maryland Department of the Environment LMA/Waste Diversion and Utilization Program
1800 Washington Blvd., Suite 610 Baltimore, MD 21230-1719
PAYMENT DUE: Send the original Form A to address above. Send a check and a copy of the completed Form A to:
Maryland Department of the Environment P.O. Box 1417
Baltimore, MD 21203-1417
Form Number: MDE/WAS/COM.020 Revision Date: 6-Jul-12 TTY Users 800-735-2258
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