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Used Oil Collection Site Registration Form

Please print and complete this Form and send to:

Your County Recycling Coordinator , e-mail to: recyclepa or mail to:

Attn: Used Oil Collection Program

PA Dept. of Environmental Protection
Bureau of Waste Management
Rachel Carson State Office Building
PO Box 8472
Harrisburg PA 17105-8472

Facility Registration Form Yes, I would like to volunteer my facility for use as a Used Oil Collection Site.

Name: ________________________________
Address: ______________________________
City: __________________________________
Zip: __________________________________
County: ______________________________
Municipality: __________________________
Lat: __________________________________
Long: __________________________________
Contact: ______________________________
Phone: _______________________________
e-mail: _______________________________
Hours of operation: ____________________

Automotive Recyclables (check all that apply):

__ Antifreeze
__ Autobodies
__ Brake Fluid
__ Inner Tubes
__ Motor Oil
__ Oil Filters
__ Transmisison Fluid
__ Vehicle Batteries
__ Tires

Comments (Any suggestions you might have about used oil recycling): 

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Signature:_____________________________________ Date:__________