CARBON CREDITS Entity requirements form

STEP C

Entity Requirements Form for the Issuance of Carbon Credits linked to plastic production or related activities
Program Participation Requirement:

To be eligible for carbon credits under this program, participating plastic recycling entities must ensure cooperation from the manufacturers who purchase their recycled plastic pellets. Specifically, manufacturers must provide, at a minimum, verifiable proof of additionality to support the calculation of the carbon credit amount. This collaboration is essential to maintain the integrity and credibility of the carbon credit issuance process.
Customer Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
E-mail
example@example.com
Transportation of Incoming Recycled Plastic
On average, how far is recycled plastic transported to reach your facility? (express in KM)*
What is the maximum distance from which recycled plastic may be sourced?(express in KM)*
Types of Plastics Recycled
Which types of plastics does your facility accept for recycling? (Please select all thatapply from the list below.)*

Polyethylene Terephthalate (PET)High-Density Polyethylene (HDPE)Polyvinyl Chloride (PVC)Low-Density Polyethylene (LDPE)Polypropylene (PP)Polystyrene (PS)Polycarbonate (PC)Acrylonitrile Butadiene Styrene (ABS)OTHER
If you selected "OTHER", please specify
Sorting Process
How is plastic sorted upon arrival at your facility?*

Sorting process manualSorting process mechanicalSorting process chemicalOTHER
If you selected "OTHER", please specify
If chemical separation is used, please specify all chemicals involved and their quantities
Input Volume and Sorting Efficiency
What is the average total weight of recycled plastic received per shipment? ( in KG) *
What is the average percentage of each plastic type sorted from incoming material? *
For the previous calendar year: What was the total volume of plastic received? ( in KG) *

For the previous calendar year: How much of each plastic type was sorted and retained for recycling? *

Rows	KG
Polyethylene Terephthalate (PET)
High-Density Polyethylene (HDPE)
Polyvinyl Chloride (PVC)
Low-Density Polyethylene (LDPE)
Polypropylene (PP)
Polystyrene (PS)
Polycarbonate (PC)
Acrylonitrile Butadiene Styrene (ABS)
OTHER

If you selected "OTHER", please specify
What percentage of received material was deemed non-recyclable and divertedto landfill (e.g., due to contamination or unacceptable material types)? *
Recycling Methodology
The recycling process is:*

MechanicalChemicalA combination of methods
If chemical or mixed methods are used, which chemicals are involved, and in what quantities?
Are condensers or similar systems used to recapture and reuse these chemicals? *
If a chemical method is used , select which type of chemical method from this list*

PyrolysisHydrocrackingSolvolysisOTHER
If you selected "OTHER", please specify

If a chemical method was selected, please specify the percentage (%) of char, gas, oil, and other byproducts that were generated

Rows	%
CHAR
GAS
OIL
OTHER BYPRODUCTS

If you selected "OTHER BYPRODUCTS", please specify
If a chemical method is selected, please indicate the type of disposal used for the char.

General LandfillHazardous Waste LandfillIncinerationOTHER
If you selected "OTHER ", please specify
Recycled Output

What quantities of each plastic type are converted into pellet form by the end of therecycling process? *

Rows	KG
Polyethylene Terephthalate (PET)
High-Density Polyethylene (HDPE)
Polyvinyl Chloride (PVC)
Low-Density Polyethylene (LDPE)
Polypropylene (PP)
Polystyrene (PS)
Polycarbonate (PC)
Acrylonitrile Butadiene Styrene (ABS)
OTHER

Water Consumption
Can you provide the average monthly water consumption at the facility?

Yes, we have precise records (e.g., from water bills)We can provide an estimateNo, we do not have this information available
If you answered YES: how much water is used during the recycling stage? ( in L per month)
What is the primary source of water used in the facility (including for sorting processes, if applicable)?

Municipal supplyGroundwaterSurface water (e.g., river, lake)Rainwater collectionRecycled water from internal processesNot sureOTHER
If you selected "OTHER," please specify
Energy Consumption
What is your facility’s total annual electricity consumption (in kWh)? *
Please specify the location of the facility *

Address

Dirección de la calle Línea 2

CityState/Province

Zip codeCountry
If known, provide the energy mix used (e.g., percentage of each source, typicallyavailable on energy bills)
Chemical Usage
What is the total quantity of each chemical used annually in your recycling processes? *
Recycling Yield
What was the total volume of plastic inputted into the recycling process over the pastyear? *
What was the total volume of recycled plastic outputted? *
Should be Empty:

STEP C

Transportation of Incoming Recycled Plastic

Types of Plastics Recycled

Sorting Process

Input Volume and Sorting Efficiency

Recycling Methodology

Recycled Output

Water Consumption

Energy Consumption

Chemical Usage

Recycling Yield