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NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid Waste Management
Solid Waste Section
SOLID WASTE KAJIAGENENT FACILITY EVALUATION REPORT
Type of Fac i I i ty_ Permit # County
Location 2�
Name of Facility k ?"Y'y
Date of Last Evaluation
I- Permit Conditions Followed k Yes No N/A
A- Specific Condition(s) Violated
II. Operational Requirements Followed Yes No
15A N-C. Admin. Code 138 Section , 0 �15 II E
A- Specific Violation(s) by nuoiber and Letter.
1�
L
111. Other Violations of Rule or Law
IV. Evaluator's
C., h, 0 Tc, C' i r�
I
V. Continuation Page Required? Yes No Receiving Signature fly
Evaluation Date I Solid Waste Section
DEHUR 3793 (Part I White: Facility Part 11 Canary: Central Office Part III Pink: Regional Office)
solid Waste Section (Review 7/94)
Maywynn: G,S,, 3,30A-294 rvKpAtNas thwaxt an evaluation prqxam be established for thhe
m-e-a-Ation of so -Lid waste mamgemrit fAcilities an a KAMM basis. The
WW�te, lk!-Teurvlc id Act Vlaste. blanagawnt Rules codified at mail WIR
M NUN! 1AB list rc-.fitix-cmm.nts- Alivii swu3t W follave-nd by solid waste
TOOIIMVY
Solid wastj-> S-ection pex-sairv-0. saaall cxuldets the evaluation farm eadi
thoy official avaluaticwis. Tha form shall be signed by
Ne ykonan(s) reoxvivArl t1y; rvpart.
Nit I Ahdta: Avility Cqp
CXW
AN
.y; Po1ei(fii cevtral office file opp
logdvimil. Wfixx; Me ccIp
vA"ri-trom Bpds Own gay he retained in ancordance with the RanxW fabskia-i and
UppvAtich Sch;alt,.Le of. the Solid Waite &-x--tion, Solid Wacwste Mmyeamm
amgark-Mt
OvIsion of the LopoxtHent of Ebviy�x=-�nt, ficaith wid Natural &--sotrtr-es.
NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid Haste Kanagement
Solid Haste Section
SOLID WASTE KAMAGE ENT FACILITY EVALUATION REPORT
A
Type of Facility !- j (,;:T L Permit # County.
Name of Facility Location
Date of Last Evaluation
I. Permit Conditions Followed Yes No N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed Yes No
15A N.C. Actin. Code 138 Section
A. Specific Violations) by number and letter.
III. other Violations of Rule or Law
IV. Evaluator's
V. Continuation Page Required? Yes No Receiving Sigreture4�
f � - . U
Evaluation Date In .1 0 Solid Haste Section
DEHNR 3793 (Part I White: Facility Part II Canary: Central Office Part III Pink: Regional Office)
Solid Haste Section (Review 7/94)
G.S. 130A 294 requires that an evaluation program be established for the
operation of solid waste management facilities on a statewide basis. The
Solid Waste Management Act and Solid Waste Management Rnles codified at
15A NCAC 13B list requirements which must be follcm€ed by solid waste
facilities.
_ Instructions: Solid Waste Section personnel shall complete the evaluation form each
time they conduct official evaluations. The form shall be signed by
the person(s) receiving the report.
- t...
Part III Canary: Raleigh central office file ccpy
Part ■■ Regional office file ter•
Disposition: This form may be retained in accordance with the Record Retention and
Disposition Schedule of the Solid Waste Section, Solid Waste Management
Division of the Department of Environment, Health and Natural Resources.
+,�,a,�rr«.-,. ten,.-- ,�ff�,:...sM-:.....r i..,.. �,. f•��.3�1'�F:;�r. fi�: _ _. , ..... �. �.. .r ro-a .�...-...- _ _ ., { �r"..y'vFr" PN,v .. �E'n.•fr.'xin,r,�tP'nzv,. �,. .. u.,....,
NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid Haste Management
Solid Haste Section
SOLID HASTE MANAGEMENT FACILITY EVALUATION REPORT
Type of Facility. Permit * county
Name of Facility Location
Date of Last Evaluation
I. Permit Conditions Followed Yes No N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed Yes No
15A M.C. Admin. Code 13B Section
A. Specific Violation(s) by number and letter.
III. Other Violations of Rule or
IV_ Evaluator's Comments
V_ Continuation Page Required? Yes No Receiving Signature
Evaluation Date Solid Haste Section
DEHNR 3793 (Part I White: Facility Part II Canary: Central Office Part III Pink: Regional office)
Solid Haste Section (Review 7/94)
Purpose: G.S. 130A-294 requirestbat an evaluation program be established for the
operation of solid waste management facilities on a statewide basis. The
Solid Waste Management Act and Solid Waste Management Rules codified at
15A NCAC 13B list requirements which must be follawoed by solid waste
facilities.
Instn=t:ians: Solid Waste Sect;on personnel shall ccuplete the evaluation form each
time they conduct official evaluations. The form shall be signed by
the person(s) receiving the report.
Di ., ...
Part II Canary: Raleigh central office file copy
Part IEEIPink: P42gicnal office file copy
Di-sp:)sitian: This form may be retained in accordance with the Record. Retention and
Disposition Schedule of the Solid Waste Section, Solid Waste Management
Division of the Department of Lnvironment, Health and Natural Resources.
NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid waste Management
Solid waste Section
SOLID WASTE MANAGEMENT FACILITY EVALUATION REPORT
i
Type of Facilityi Permit County
r ri�
i ��p�+
Name of FacilityA•%�yr�iP. �-. �.: s l,, ! s�,^�,--iXl.l �? Locati,
Date of Last Evaluation
I. Permit Conditions Followed � Yes No N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed _Yes No
r
15A N.C. Admin. Code 13B Section ••, J
A. Specific Violation(s) by number and Letter.
III. Other Violations of Rule or Law
IV. Evaluator's Comments
V. Continuation Page Required? Yes No Receiving Signature, )
Evaluation Date Solid Waste Section �.
DEHNR 3793 (Part I White: Facility Part II Canary: Central Office Part III Pink: Regional Office)
Solid Waste Section (Review 7/94)
Purpose: G.S. 130A-294 requires that an evaluation pin be established for the
operation of solid waste management facilities on a statewide basis. The
Solid Waste Management Act and Solid Waste Management Rules codified at
15A NCAC 13B list requirements which must be followed by solid waste
facilities.
Instructions: Solid Waste Section personnel shall cmplete the evaluation form each
time they conduct official evaluations. The form shall be signed by
the person(s) receiving the report.
Distribution: Part I White: facility copy
Part I is Raleigh e w office file co'..
Part III Pink: Regional office file -it —Ur
Disposition: This form may be retained in accordance with the Record Retention and
Disposition Schedule of the Solid Waste Section, Solid Waste Management
Division of the Department of Environment, Health and Natural Resources.