BLS-Green Form 326 Green Form 326199

Green Goods and Services Survey

O.M.B. No. 1220−0181

Expires September 30, 2010

Please return this form within 14 days. If you need help completing this form, contact information is listed on the last page. Thank you!

Statename

UI (10 digits)

Please report for location(s) in Using Unemployment Insurance account number

1

What is the address where your business establishment is physically located?

Report data for the location below. If this address is no longer correct, please provide us with an updated address in the space provided.

Enter Physical Location Address Corrections Here

T_name

Phy_addr2

PHY_addr1

Phy_city, Phy_state phy_zip-phy_zip_ext

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2

ave we identified your main business activity correctly?

We have listed below a description of your main business activity at this location. If this description is incorrect, please call 202-691-5185 or email [email protected].

NAICS code: 326199 All other plastics product manufacturing
We have identified your main business activity as the following:		Does NOT include:
Establishments primarily engaged in: Manufacturing plastics products		Assembling plastic components into plumbing fixture fittings such as faucets Foam (except polystyrene) products Heavy-duty inflatable plastics boats Laminating plastics profile shapes, such as plate, sheet, and rod Plastics bottles Plastics film, plastics unlaminated sheet, plastics bags Plastics furniture parts and components Plastic pipes, pipe fittings, plastics profile shapes (except film, sheet, bags) Plastic plumbing fixtures Polystyrene foam products Resilient floor coverings

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3

hat is your business establishment’s fiscal year?

Please provide us with your fiscal year that includes April 15, 2009 for the location listed in Item 1.

Start of Fiscal Year				End of Fiscal Year
MM	DD	YYYY		MM	DD	YYYY

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4

hat is your business establishment’s employment?

Please provide us with the employment figure you reported on your State’s Quarterly Contributions Report for September 2009 for the location listed in Item 1. This figure is the count of all employees subject to State Unemployment Insurance taxes that worked or received pay for the pay period that included September 12^th, 2009.

Employment for pay period that includes September 12, 2009

5

What is your percent revenue from specific product lines?

In Columns 1 and 3, please estimate the percent of total revenue for the location listed in Item 1 from products containing more than 50% recycled or spent plastic resins. Please base your estimate on total revenue for your fiscal year from Item 3. The sum of Columns 1 and 3 may not equal 100%.

Note: This section may best be completed by someone at your firm with access to financial data.

Percent of total revenue for fiscal year listed in Item 3

1 Percent of total revenue for products with greater than 50% recycled or spent resins	2 Product line		3 Percent of total revenue for products with greater than 50% recycled or spent resins	4 Product line
	Awnings, rigid plastics or fiberglass, manufacturing			Lens blanks, plastics ophthalmic or optical, manufacturing
	Badges, plastics, manufacturing			Mattresses, air, plastics, manufacturing
	Balloons, plastics, manufacturing			Microwaveware, plastics, manufacturing
	Bathroom and toilet accessories, plastics, manufacturing			Motor vehicle moldings and extrusions, plastics, manufacturing
	Bolts, nuts, and rivets, plastics, manufacturing			Netting, plastics, manufacturing
	Bottle caps and lids, plastics, manufacturing			Nozzles, aerosol spray, plastics, manufacturing
	Bowls and bowl covers, plastics, manufacturing			Organizers for closets, drawers, and shelves, plastics, manufacturing
	Bubble packaging materials, plastics, manufacturing			Packaging, plastics (e.g., blister, bubble), manufacturing
	Building materials (e.g., fascia, panels, siding, soffit), plastics, manufacturing			Pails, plastics, manufacturing
	Building panels, corrugated and flat, plastics, manufacturing			Paint sticks, plastics, manufacturing
	Bushings, plastics, manufacturing			Picnic jugs, plastics (except foam), manufacturing
	Cigar and cigarette holders, plastics, manufacturing			Radio housings, plastics, manufacturing
	Clothes hangers, plastics, manufacturing			Reels, plastics, manufacturing
	Clothespins, plastics, manufacturing			Reflectors, plastics, manufacturing
	Combs, plastics, manufacturing			Rulers, plastics, manufacturing
	Coolers or ice chests, plastics (except foam), manufacturing			Screening, window, plastics, manufacturing
	Countertops, plastics, manufacturing			Septic tanks, plastics or fiberglass, manufacturing
	Credit and identification card stock, plastics, manufacturing			Shoe parts (e.g., heels, soles), plastics, manufacturing
	Cultured marble products (except plumbing fixtures) manufacturing			Shutters, plastics, manufacturing
	Cultured stone products (except plumbing fixtures) manufacturing			Siding, plastics, manufacturing
	Cups, plastics (except foam), manufacturing			Sponges, plastics, manufacturing
	Dinnerware, plastics (except polystyrene foam), manufacturing			Swimming pool covers and liners, plastics, manufacturing
	Doormats, plastics, manufacturing			Swimming pools, fiberglass, manufacturing
	Doors and door frames, plastics, manufacturing			Tanks, storage, plastics or fiberglass, manufacturing
5	Drums, plastics (i.e., containers), manufacturing			Television housings, plastics, manufacturing
	Footwear parts (e.g., heels, soles), plastics, manufacturing			Tires, plastics, manufacturing
	Fruits and vegetables, artificial, plastics, manufacturing			Trash containers, plastics, manufacturing
	Gloves, plastics, manufacturing			Tumblers, plastics, manufacturing
	Gutters and down spouts, plastics, manufacturing			Utility containers (e.g., baskets, bins, boxes, buckets, dishpans, pails), plastics (except foam), manufacturing
	Hampers, laundry, plastics, manufacturing			Watch crystals, plastics, manufacturing
	Handles (e.g., brush, tool, umbrella), plastics, manufacturing			Watering cans, plastics, manufacturing
	Hardware, plastics, manufacturing			Window sashes, vinyl, manufacturing
	Ice buckets, plastics (except foam), manufacturing			Windows and window frames, plastics, manufacturing
	Jars, plastics, manufacturing			Windows and window frames, vinyl, manufacturing
	Kitchen utensils, plastics, manufacturing			Windshields, plastics, manufacturing
	Ladders, fiberglass, manufacturing			Other (please specify):
	Lamp shades, plastics, manufacturing			Other (please specify):

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6

hat is your contact information? For the person or persons who helped complete this form.

1. Contact 1’s name: __________________________________________

Title:___________________________________

Phone number: (_____)________ - _____________________ email:__________________________________

Business website:______________________________________________

2. Contact 2’s name: ____________________________________________

Title:___________________________________

Phone number: (_____)________ - _____________________ email:________________________________

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Do you have any questions about completing this form?

Please send an email to [email protected], or call (202)-691-5185.

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onfidentiality Statement. The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. This report is authorized by law 29 U.S.C.2. Paperwork Reduction Act Statement. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate, and timely. We estimate that completing this form will take an average of 20 minutes. This estimate takes into account time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. If you have any comments regarding this survey, including suggestions for reducing the burden, send them to the Bureau of Labor Statistics, Office of Industry Employment Statistics, Paperwork Reduction Project, 2 Massachusetts Avenue, N.E., Room 4840, Washington, DC 20212. The OMB control number for this voluntary survey is 1220-0181 and expires on September 30, 2010. Without a currently valid number BLS would not be able to conduct this survey.

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