Henderson County Engineering

Solid Waste and Environmental Programs Division

Mercury Products Recycling Data Form

INSTRUCTIONS: Please fill out the form below, then PRINT and SUBMIT the form using the buttons at the bottom. Bring the printed form to the Convenience Center, located at 265 Convenience Center Drive, off of Stoney Mountain Road. THE FORM MUST BE SIGNED IN THE PRESENCE OF SOLID WASTE STAFF.

Recycling Logo

Are you a Henderson County resident? Yes No      
Name
Address
City
State
Zip Code
         

I certify that I am a resident of Henderson County and that this waste was generated from my residence. I understand that it is illegal for me to bring waste from my business under this program. All container labels specify the true contents, to the best of my knowledge, of each labeled container. I do not have explosives, ammunition, radioactive, or bio-infectious materials with my waste.

Signature: _______________________________________________________________________________
         
Please detail the sections below about your products to be recycled:
         
UNIVERSAL WASTE LAMPS** AMOUNT   BALLAST/CAPACITORS/FIXTURES AMOUNT
≤ 4-foot fluorescent tubes*   PCB Ballast
8-foot fluorescent tubes*   Capacitor
CFL's (compacts)   ≤ 4 foot 2- or 4-bulb fixtures
U-shape or circular lamps   8-foot 2- or 4-bulb fixtures
HID or LPS lamps   Other (please describe)
       
Neon lamps   MERCURY-CONTAINING DEVICES AMOUNT
UV lamps   Thermostats (wall-mounted)
Shield lamps   Thermometers
Projector lamps   Barometers
Flood, plastic encased spots   Elemental
Other HG lamps, bulbs   Other (please describe)
         
*PLEASE DO NOT TAPE BULBS TOGETHER
**PLEASE ALERT STAFF IF YOU HAVE BROKEN MATERIALS!
         
Please print AND submit this form.