Recycler Application Form
A
Recycler Qualification Program (2010)
APPLICATION TYPE
I am a Primary Recycler seeking approval under the RQP
I am an approved Primary Recycler seeking an amendment to my scope of approval
I am an approved Primary Recycler seeking approval for a Downstream Recycler
B
APPLICANT INFORMATION
Company Name:
Representative:
Address:
Phone:
City:
Email:
Province/State:
Postal/Zip:
Indicate all facilities covered under this application:
C
Site/Facility Contacts:
FOR APPLICATION OF A NEW PRIMARY RECYCLER OR AN AMENDMENT TO EXISTING APPROVAL
Check all products accepted at this Site/Facility
CRT Displays
Portable Audio/Video Equipment
Projection Displays
Home Audio/Video Equipment
LCD Displays
Speakers
Plasma Displays
Vehicle Audio & Video Systems
Desktop Computers
Non-cellular Telephones and Answering Machines
Portable Computers
Cellular Devices
Desktop Printers
Other:
Floor Standing Copy and Printer Devices
Other:
Provide a description of the Include any details pertaining to the material type, processing methods/equipment, and
operations for which you are processing rates.
seeking approval:
D
FOR DOWNSTREAM RECYCLER APPLICATIONS
Company Name:
Representative:
Address:
Phone:
City:
Email:
Province/State:
Postal/Zip:
Provide a description of the
operations for which you are
seeking approval:
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Include any details pertaining to the material type, processing methods/equipment, and
processing rates.
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Recycler Application Form
E
DOWNSTREAM PROCESSING INFORMATION
Check all materials generated by Primary
Recyclers or Accepted by Downstream
CRT Yokes
CRT Panel
CRT Funnel (leaded)
Mercury Bulbs (LCD, scanner, etc.)
Ethylene Glycol (Projection TV CRT)
LCD Panels
Plasma Panels
Circuit Boards
Wires and Cables
Rechargeable Batteries
Non-rechargeable Batteries
Components (Hard drives, chips, etc.)
Toner and Inks
Steel
Aluminum
Copper
Brass/Bronze
Copper bearing materials
Metal Fines
Wood
Glass (non-leaded)
Plastics
F
Recycler Qualification Program (2010)
Description of Processing Method
Downstream Recycler &
Final Disposition
POLICIES & PROCEDURES
Attach a copy of the following Policies and Procedures (or equivalent documentation). If you do not attach a copy of any of the
following, include reason for the omission. Ensure to provide clear direction to all submitted documents.
Document Reference / Indicator or
Document
Document Type
Reason for Omission
Attached
Regulatory permits, licenses, & approvals to operate
Insurance coverage
Worker compensation coverage
Certifications (ISO, R2, eStewards, etc.)
Internal ERS conformance audit (Date & results)
Site/floor plan, pictures and/or process flow diagram
Downstream Flow Diagram/Chart
Process/procedure for Downstream Recyclers Evaluations
EHS Policy
EHS Training Program
Summary of training requirements
Worker hygiene policies
Procedure for secure storage and handling of data containing products
Sample of other relevant EHS policies, procedures or work instructions
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Recycler Application Form
Recycler Qualification Program (2010)
EHS risk assessment process
List of any regulated/hazardous materials & handling procedures
Air, noise and/or medical sampling programs
Emergency Response Programs & Procedures
Procedure for identifying regulatory requirements
Summary of legal requirements (include applicability to operations)
Procedure to schedule and conduct audits and inspections
Audit and inspection schedule
Site closure plan & Financial assurance
Contingency plan for interruptions in service
Procedure for tracking and reporting program materials
Procedure for providing notice of reportable incidents to RQO
Transport or export permits
Process to evaluate Transporters
Procedure for transportation of regulated materials
G
APPLICABLE FEES AND PAYMENT
A fee of $1 500 + applicable taxes is applicable for the submission of this application.
A reduced fee of $1 100 + applicable taxes is applicable if the applicant is a registered not-for-profit organization.
Contact info@rqp.ca for total invoice amount including applicable taxes.
A cheque payable to the Electronic Products Recycling Association is attached to this application.
A cheque payable to the Electronic Products Recycling Association has been mailed separately to:
Electronic Products Recycling Association
5750 Explorer Drive, Suite 301
Mississauga, ON L4W 0A9
The fee submitted applies to this application only and is non-refundable. Re-submission for an incomplete or nonconforming
application is subject to an additional application fee.
H
CONFIRMATION OF ACCURACY & COMPLETENESS OF APPLICATION
The applicant is responsible for ensuring that adequate information is provided. Incomplete applications will not be assessed.
Confirm and verify each of the following:
I verify that all supporting information indicated above has been provided in the application.
I verify that all information submitted is current and valid at the time of submission of the application.
I verify that the facility currently operates in compliance with all applicable regulatory requirements and the requirements
of the ERS.
Should it be determined that any false information has been provided or any part of the organization, recycling operations or
processes undertaken are misrepresented, the application will immediately be rejected.
Date of
Signature of Applicant:
Submission:
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