NCTH06320011_Application_10/6/2020

A household hazardous vaste I.D. number shalI be required to ship collected materialsoff-site for treatment and/or processing.
Please ched<the appropriate box and fill in the blank
Facility/Event Host Details l'_`J
Facility/EventHost*
Moore County
Contact Person*
David Lambert
Mailing Address Street*
PO Box 1927
City*
Carthage
Postal/Z p Code*
28327
NCTH 06320011
Approved 10/06/20
John
State * NC Patrone
County* Moore
Digitally signed by
John Patrone
Date: 2020.10.06
12:50:15-04'00'
Phone* [phone] Email* [e-mail]
Operator/Contractor ^
On -site Contractor*
Ecoflo, Inc
Contact Person*
Scott Peele
Mailing Address Street*
2750 Patterson St
City*
Greensboro
Postal/Zip Code*
27407
State* NC
Phone* [phone] Email [e-mail]
Transporter
Company Name*
Ecoflo, Inc
ID Number
NCD980842132
Contact Person*
Scott Peele
Mailing Address Street*
2750 Patterson St
City*
Greensboro
Postal/Zip Code*
27407
State* NC
Phone* [phone] Email [e-mail]
Dispose r/Re cycler
Company Name*
Ecoflo, Inc
ID Number
NCD980842132
Contact Person*
Scott Peele
Mailing Address Street*
2750 Patterson St
City*
Greensboro
Postal/Zip Code*
27407
Phone*
[phone]
State* NC
Email [e-mail]

Collection Details
Physical Location of Pinecrest High School
Event/Facility* 250 Voit Gilmore Lane
Southern Pines, NC 28387
Date of Temporary Event 11 /21 /2020
(if applicable) *
Event Start Time* 10:00:00 AM
Event End Time* 02:00:00 AM
Materials to be Paints, pesticides, fluorescent light tubes
Collected*
Materials to be Recycled* Fluorescent light tubes, lead acid batteries
Additional Comments Pesticides in conjunction with NCDA
Certification of Operator/Contractor
I certify that the information supplied is accurate and correct to the best of my knowledge and belief, and that
this facility will only accept household hazardous waste. I am authorized to make this request on behalf of the
operator at the location given.
Signature*
sr"O,k 5 Peele
Date 09/19/2020
Email* [e-mail]