HTML Preview Lubricating Purchase Receipt page number 1.
State of California
Department of Resources Recycling & Recovery (CalRecycle)
CalRecycle 326 (Rev. 4/17)
LUBRICATING OIL PURCHASE RECEIPT
Department of Resources Recycling and Recovery (CalRecycle)
Used Oil Recycling Program
1001 I Street, MS 9-A
Sacramento, CA 95814
, purchases:
Lubricating oil and pays the $0.24 per gallon California Recycling Fee.
Re-Refined lubricating oil and pays the $0.12 per gallon California Recycling Fee.
Each claim form submitted will contain the estimated n
umber of total gallons for lubricating oil and re-refined
lubricating oil purchased.
The Department of Resources Recycling and Recovery (CalRecycle) (formerly the California Integrated Waste
Management Board) will receive notification of changes to or the addition of vendors from whom lubricating
oil is purchased. For purposes of State audits, this company will maintain copies of purchase receipts together
with all bills, receipts, invoices, manifests, cash register tapes, or other documents of original entry supporting
these purchases for at least three years from the date of purchase. These documents must be prepared and
retained in accordance with generally accepted accounting principles and good business practice.
This company purchases such oil from the following vendor(s):
Name:
Address:
Name:
Address:
Name:
Address:
Name:
Address:
I declare under penalty of perjury under the laws of the State of California that I am authorized to legally bind
Claimant and that to the best of my knowledge and belief the following statements are true and correct:
1) That the information provided in this form is complete and correct; and
2) That Claimant has operated in compliance with all Federal, State and local requirements pertaining to the
management of this oil.
Signature of Representative of Claimant Date:
Title of Representative (please print)
Certification Number:
This company,
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