3609TP-HHW- Gaston County HHW Collection Facility SW019-0109 PARF & Invoice 11-12-19

PERMIT APPLICATION REVIEW FORM
Review Requested by: David Giachini
Date Application Received: November 01, 2019
Location ID (if known) P0961
Permit ID 3609TP-HHW-
Permit Name
(aka Permit Applicant Name) Gaston County HHW Collection Facility
Facility Type HHW
Physical Street Address 120 Leisure Lane
City, State, Zip, County Dallas, NC, 28034, Gaston
Description of Permit Request (1)a. New – New Facility
(1)b. New – Expand Facility Boundary
(1)c. New – Expand Waste Boundary
(1)d. New – Substantial Amendment
(2)a. Amendment – Next Phase of the Approved Facility Plan
(2)b. Amendment – Renewal/Review 5YR LOS
(2)c. Amendment – Change in Ownership
(3)a. Modification – Change to Approved Plans (No CHR)
(3)b. Modification – Subsequent Permit to Operate (No CHR)
(3)c. Modification – Five-year Limited Review
(4) Major Permit Modification
Permit Fee $0.00 Facility Contact Mailing Address Contact Name, Title Ms. Marcie Smith, Solid Waste and Recycling Administrator
Phone # [phone]
Email Address [e-mail]
Company Gaston County Dept. of Public Works
Facility Contact Street 3155 Philadelphia Church Road
City, State, Zip Code Dallas, NC, 28034 Billing Contact Mailing Address Contact Name, Title Ms. Marcie Smith, Solid Waste and Recycling Administrator
Phone # [phone]
Email Address [e-mail]
Company Gaston County Dept. of Public Works
Facility Contact Street 3155 Philadelphia Church Road
City, State, Zip Code Dallas, NC, 28034
Other notes
Permit Name – This is the name on the permit
Facility Contact Address – May not be the facility address.
For Facility and Billing Contact check Annual Facility Report and latest inspection on Laserfiche.
SW019-0109
North Carolina Department of Environmenal Quality
Division of Waste Management
Solid Waste Section
INVOICE
Invoice #:SW019-0109
Date:11/12/2019
Payment Options:
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
phone: [phone] fax: [phone]
email: [e-mail]
To:Marcie Smith, Solid Waste and Recycling Administrator
Gaston County HHW Collection Facility
3155 Philadelphia Church Road
Dallas, NC 28034
More information available on the web:
North Carolina Department of Environment and Natural Resources (DENR) - http://portal.ncdenr.org/
North Carolina Solid Waste Program - http://portal.ncdenr.org/web/wm/sw
North Carolina Electronics Management Program - http://portal.ncdenr.org/web/sw/electronics
E-check -Available online at http://go.ncdenr.gov/swpay
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card -Available online at http://go.ncdenr.gov/swpay
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
*Convenience Fee of 2.65% added to amount invoiced.]
Paper check -Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number
on check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy
of this invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Remit paper checks to:
N.C. Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Description Amount Due
Facility-Application:
Gaston County HHW Collection Facility (3609TP-HHW-)
120 Leisure Lane
Dallas, NC 28034
Permit Renewal Application (Amendment- Five-Year Renewal) received on 11/1/2019
$0.00
$0.00Total Amount Due
12/12/2019Date Due
Pursuant to North Carolina General Statute 130A-295.8 you are required to pay fee(s) based on your solid waste management activities. The fee(s)
shall be used to support the solid waste management program. An application is deemed incomplete until all fees are received.
Explanation of Invoice Amount is Based on Facility's Current Permit Application:
Billing process:
Mary H. Johnson [phone]
Ed Mussler [phone]
Solid Waste Contacts:
Regulations and Technical Assistance:
Ed Mussler [phone] Landfills, Transfer Stations
Adam Ulishney [phone] Land Application Sites, Compost Facilities
NC Solid Waste Invoice Form I-2014