NC Electronics Manufacturer Annual Reporting Form

State of North Carolina Department of Environmental Quality, Division of Waste Management - Solid Waste Section

The Discarded Computer Equipment and Television Management Act:
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North Carolina General Statute 130A-309.134(h) and NCGS 130A-309.135 (g) requires that manufacturers of computer equipment and manufacturers of televisions submit a report to the Department by October 1 of each year stating the total weight of all computer equipment and/or televisions collected for recycling and reuse in the State during the previous fiscal year [July 1 through June 30].
Date*field type date
Manufacturer Name:*field type single line
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Toll Free Recycling Information Phone # (Required for Computer Equipment Manufacturers, or Television Manufacturer Phone #):*field type single line
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Website Address:*field type single line
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Primary Contact:*field type single line
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Direct Phone #:*field type single line
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E-mail Address:*field type email
This report is for:*field type checkbox
This report is for:Computer EquipmentTelevisions
(check all apply)
Manufacturer Program Registration Number:field type single line
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List the collection point name and type, recycling facility, and weight for computer equipment collected at each collection point. Attach documentation that shows the electronics were claimed by the recycler(s) used for each collection point, and that the computer equipment was discarded by consumers in North Carolina. Supporting documentation is required upon request.
Do Not Include Data for Television Collection. Television Collection Data is Reported Separately from Computer Equipment Collection on this Form.
Computer Equipment Collection Point Information
Add a row for each Collection Point.
×
- Collection Point Name:*(?)field type single line
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- Collection Point Type:*(?)field type radio button
  Collection Point Type:PermanentRetailOne-Time EventMail back
- Is the Collection Point a Local Government Collection Program?*(?)field type radio button
  Is the Collection Point a Local Government Collection Program?YesNo
- Recycling Facility Name, Address, and Phone #:*(?)field type multi line
- Weight (lbs) Collected:*field type number
- Is there a Third-Party/Intermediary Between the Manufacturer and the Recycling Facility? If so, Provide Contact Information:field type multi line
+Add More Collection Points
Computer Equipment Totals, Brands, and Manufacturer Plan Level
Total Weight (lbs) of Computer Equipment Collected for Recycling or Reuse in North Carolina:*field type number
Total Weight (lbs) of Computer Equipment Collected for Recycling or Reuse from North Carolina:*field type number
Computer Equipment Manufacturer Brand Names Sold Currently in North Carolina:*field type multi line
Computer Equipment Manufacturer Recycling Level:*field type radio button
Computer Equipment Manufacturer Recycling Level:Level ILevel IILevel III
Summary of the Computer Equipment Manufacturer's Recycling Plan referencing the requirements per NCGS 130A-309.134(c):*field type multi line
Documentation Uploadfield type file upload
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List the collection point name and type, recycling facility, and weight for televisions collected at each collection point. Attach documentation that shows the televisions were claimed by the recycler(s) used for each collection point and that the televisions were discarded by consumers in North Carolina. Supporting documentation is required upon request.

Do Not Include Data for Computer Equipment Collection. Computer Equipment Collection Data is Reported Separately from Television Collection on this Form.
Television Collection Point Information
Add a row for each Collection Point.
×
- Collection Point Name:*(?)field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- Collection Point Type:*(?)field type radio button
  Collection Point Type:PermanentRetailOne-Time EventMail back
- Is the Collection Point a Local Government Collection Program?*(?)field type radio button
  Is the Collection Point a Local Government Collection Program?YesNo
- Recycling Facility Name, Address, and Phone #:*field type multi line
- Weight (lbs) Collected:*field type number
- Is there a Third-Party/Intermediary Between the Manufacturer and the Recycling Facility? If so, Provide Contact Information:field type multi line
+Add More Collection Points
Television Totals, Brands, and Market Share Recycling Obligation
Total Weight (lbs) of Televisions Collected and Recycled in North Carolina:*field type number
Total Weight (lbs) of Televisions Collected and Recycled from North Carolina:*field type number
Television Manufacturer Brand Names Currently Sold in North Carolina:*field type multi line
Annual Manufacturer Market Share Recycling Obligation:*field type single line
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Is the Total Weight Recycled Equal to or Above the Annual Television Manufacturer's Market Share Recycling Obligation?*field type radio button
Is the Total Weight Recycled Equal to or Above the Annual Television Manufacturer's Market Share Recycling Obligation?YesNo
Per NCGS 130A-309.135(c), the obligation to recycle televisions shall be allocated to each television manufacturer based on the television manufacturer’s market share. A television manufacturer must annually recycle or arrange for the recycling of its market share of televisions.
If the total weight recycled was less than the Manufacturer's Market Share Recycling Obligation, provide an explanation as to why it was not met and what will be done to meet the Market Share Recycling Obligation in the future.field type multi line
Per NCGS 130A-309.135(d), a television manufacturer is required to conduct and document due diligence assessments of the recyclers the manufacturer contracts with, including an assessment of compliance with environmentally sound recovery standards. Ensure due diligence assessments are conducted. Supporting documentation is required upon request.
Documentation Uploadfield type file upload
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Were the Television Manufacturer's unit sales minimal such that it was not directed by the Department to meet a Market Share Recycling Obligation? (This is uncommon.)field type radio button
Were the Television Manufacturer's unit sales minimal such that it was not directed by the Department to meet a Market Share Recycling Obligation? (This is uncommon.)Check If Yes

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