OAKLAND WAREHOUSE
Hours
Tuesday - Friday
8am to 4pm
Saturday - Sunday
9am to 3pm
721 37th Ave.
Oakland, CA 94601

Universal Waste Management, Inc.

A California State Approved Collector and Recycler of Electronic Waste

1.888.832.9839

"UnWaste Your World"

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Universal Waste Management E-Waste Form

Please print out this form, fill it out, and bring it with you.
Please fill out this form accurately.
We will not sell your information or contact you without your permission.

ITEMS ELIGIBLE FOR COLLECTION
Name: _________________	Phone Number:_(___)_______
(if business, then business name)
Street: ___________________
	Zip Code: __________________
City: ______________________
quantity of CRT's: (Televisions or monitors) * The State requires an explanation for any organization, business, or residence disposing of 5 or more CRTs at one time. Reason: F=Faulty; U=Upgrade; C=Clean Up; L=Liquidation; S=Small business; D=Damaged; O=Other (specify)	5 or more: Contact Name: Contact Phone: ( ) Specify here if other:
quantity of CPU's: (Computer systems)	****FOR OFFICE USE ONLY**** WEIGHT:
quantity of Other / Peripherals:	****FOR OFFICE USE ONLY**** WEIGHT:
Accepted E-Waste
Computers, monitors, computer components, printers, fax machines, copy machines, TV's, VCR's, DVD players, toner cartridges, telephone equipment, cellular phones, power supplies, MP3 players.
*NO car batteries
Signature Required
By signing below you have hereby verified that all items, inventoried or unlisted, left in the possession of Universal Waste Management have been purchased and operated on within the borders of the State of California.
Signature ________________________________	Date ___________________
Universal Waste Management, Inc.
721 37th Ave
Oakland California, 94601
(888) 832-9839