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pointcone <br />ar, <br />Activity Report for Reimbursement <br />For direct reuse and other activities <br />Description Units Unit of <br />Measure Price Amount Activity <br />Code <br />Latex Paint Reuse Gallons 1.60 P-6834 <br />Oil-Based Paint Reuse Gallons 1.60 P-6834 <br />Reprocessing P-6835 <br />Bulking Latex Paint P-6386 <br />Bulking Oil Based Paint P-6387 <br />I nternal Transpoftation* <br />Use this line to report the <br />number of boxes or trips at the <br />negotiated rates for internal <br />Transportation. <br />T-6350 <br />Total (should match invoice) <br />*For internal transportation, also provide a list of container weights for each bin or drum. A sample list <br />is shown on the next page <br />lnvoice Date <br />lnvoice or Reference # <br />Paintcare Contract Number* <br />Service Month <br />Company/Organization <br />PaintCare Site lD <br />(Please contact your contact at PaintCare if you <br />do not know your contract or site lD number.) <br />Facility Street Address <br />Facility City-State-Zip <br />Contact Person <br />Contact Phone <br />Contact Email <br />Mailing Address for Payment <br />E-2