HomeMy WebLinkAboutNCTH04121054_Application_9152021A household hazardous waste 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
Facility/EventHost* City of High Point
Approved 9/15/21
Contact Person* Tim Daut No. 04121054
Mailing Address Street* 1401 E Martin Luther King Jr Drive
City* High Point State* NC
Postal/ZpCode* 27260 County* Guilford
Phone* 336-823-0756 Email* tim.daut@highpointnc.com
Operator/Contractor
On -site Contractor* Mxi Environmental Services LLC
Contact Person* Peggy Snead
Mailing Address Street* 26319 Old Trail Road
City* Abingdon
Postal/Zp Code* 24210
State * VA
Phone* 2766286636 Email peggys@m)dinc.com
Transporter
Company Name* Maumee Express Inc
ID Number NJD986607380
Contact Person* Chris Widener
Mailing Address Street* 26319 Old Trail Road
City* Abingdon
Postal/Zip Code* 24210
State * Va
Phone* 2766286636 Email peggys@m)dinc.com
Dispose r/Re cycler
Company Name* MXI Environmental Services LLC
ID Number VAR000503920
Contact Person*
Peggy Snead
Mailing Address Street*
26319 Old Trail Road
City*
Abingdon
Postal/Zip Code*
24210
Phone*
2766286636
State * VA
Email peggys@m)dinc.com
Collection Details
Physical Location of 1401 E Martin Luther King Jr Drive high Point NC 27260
Event/Facility*
Date of Temporary Event 11 /6/2021
(if applicable) *
Event Start Time* 08:00:00 AM
Event End Time* 02:00:00 PM
Materials to be Household Hazardous Waste
Collected*
Materials to be Recycled* antifreeze, motor oils, fluorescent and CFL bulbs, Latex paints, batteries, fire
extinguishers, mercury
Additional Comments
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*
rht PAV7-
Date 09/15/2021
Email * tim.daut@highpointnc.gov