88B_ROSCANS_1997

ARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid haste Management
Solid Waste Section
SOLID WASTE NANAGEIENT FACILITY EVALUATION REPORT
Type of Facility.
Name of Facility
Date of Last Evaluation
Permit * county.
Location t 1:
I. Permit conditions Followed Yes No N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed Yes No
15A N.C. Admin. Code 13B Section
A. Specific Violations) by number and letter.
III. Other Violations of Rule or Law
IV. Evaluator's Carments
V. Continuation Page RequirecP 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)

A, '130.A-294 Ye{on programi be b&hfor
r the
IJJ-M-s t-bat an O-Valix-Iti-
rati.�.Jn oj.jid w-)ste inawxrmont. facilities on a statewid(-:� ba.s.is. 'The
Solid- Waste. blanagement Act. ar)-J. S(,).tid Waste Manageffent Pales coW.fied at
-TV 13,';-1 Ist -VA-lich nmt, be folluAad hy Solid waste-
"SkOd"Ji soze:c-t-lor-i ppxsomrk--I shall cxxq-)Iete Ume evaluation for each
they ('xinlix-4- officia-I evaluations. 1.11-in form sball, be siTwd by
t1ie pexws) rer--x-d-virg the report-.
i,. aart I Miite,.- facrd-ty cr4w,
II Ci5 3PT . Pal-eigh canU-al offii.,3e file cxw
ATice file cop ut 11-T Ak. P!-RiEVicml. of y
Retention and -MFI-V he -rmtedned in acxxzdamitr �e wh the Recod
Me le of U Solid WSeution, lid ilaste Wurvaqeuerit
oi of �,-he uq�rIL(rauL of 1�, -kcorment, Health and Natural Resources.

NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid Waste Management
Solid Waste Section
SOLID WASTE NANAGE ENT FACILITY EVALUATION REPORT
Type of Facility. Permit * County.
Name of Facility. Locatii
Date of Last Evaluation
I. Permit conditions Followed Yes No N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed Yes
15A N.C. Admin. Code 13B section
A. Specific Violations) by number and letter.
III. Other Violations of Rule or
IV. Evaluator's Comments
No
V. Continuation Page Required? Yes No Receiving Signature
Evaluation Date Solid Waste Section
DEHMR 3793 (Part I White: Facility Part II Canary: Central Office Part III Pink: Regional Office)
Solid Waste Section (Review 7/94)

bra . 13OA-294 znquires that an evaluatirgi raisgromi ke eetablishad far Uhe
CTOTation of Solid- va-ste nurn,nent facilities on a statewide hasisqTbhF-
Solid Waste Management Ict and Solid Waste Manaqexkan-t- hules codified at
INk NC K 13B list requirempe-Abs Mict nont Ime followed by solid waste
facilities.
chn parsonnel shall complete the evaluation farm each JUadws,:, Solid Waste Sectia
tine tbey c(-jrYtR-,t official evaluations. The form shall be signed by
tAR TxrrszRQ) recxvivixyj tiva isq?orin
MASUArn: Part I fbite: facility cxjj
CCW
,ax-t 1-1, Cax�.- IYAQ certral office Me acpy
-ITT 10girawil cifflkx: f!Jja Cq;
OW
This form w-ty Ixt rawaWNI K xvirdousne with the Rec;ord Retention and
i)ixsiticwi schecti-le of the SUM baste Section, Solid Waste Manac
ukvi-;ion of the Dq>-arbarkmt of &tvirorwent, Health and N[ataxal Pesources.

#>IRIRY _•;-c`Wr-�c' G. :uJ,!F" it { �;,�'l�A.'=d�LA sty.. � �.,: _..'r-rf .r,. , tr ---��n: ",ctt !;-T'.A +�.1��FF 19' a�.�; csa'em:� v� si5: _ r tip"x"•"? 1'R-1 .: fit+}" ,.. .. .-. .,
NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid Waste Management
Solid Waste Section
SOLID WASTE MANAGEMENT FACILITY EVALUATION REPORT
Type of Facility.
Permit
County.
i—_
Name of Facility
f
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_ Admin. Code 13B Section
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
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/%)

iRl
Utjlrk ' G.S, 130A-294 rcqpAre-, that an t-waluation pram ablished for the
rl!�,m-ltion cif solic't wastp- iTaragement tacibtic�s cFri a statawide ba:,,,isIMP,
boiid Waste M-Aagaaanit AaL and Solid Was -Le Mamqeueiit IwIes caiified at
I 14CIACI 13,03 'n-,xju-JrejY)e'tTts .-c4dch xamt. be follcmed by solid mct�stc
eva-luat. ai form eadi
s-tjall the
tut off-i-ca-al emaluaticintz;7. The foun shall. be signed by
Tic Owy -,I�A of Z file
TbJls. farm -may be reta-iy.ved in ac=rdance- with the P�rd Rptention aryd
of the SoIid Waste. Section, Solid as Markagexerit
01" the be .,rtavxit, of Enviro.y.-mant, Health and Natural Reources.

NC DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
Division of Solid waste Management
Solid Waste Section
SOLID WASTE KANAGENENT FACILITY EVALUATION REPORT
Type of Facility Permit 1 County.
J,Al
Name of Facility ",� 1) / /
T 04i i'l Location
Date of Last Evaluation
I. Permit Conditions Followed Y Yes No _ N/A
A. Specific Condition(s) Violated
II. Operational Requirements Followed '/ Yes No
15A N.C. Admin. Code 138 Section
A. Specific Viotation(s) by rustier and letter.
(-> V1dkp,1
III. Other Violations of Rule or Law
IV. Evaluator's Commients
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 Ill Pink: RegionaL Office)
Solid Waste Section (Review 7/94)

PurPose: 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 Rules codified at
15A NCAC 13B list requirements which must be followed by solid waste
facilities.
Instr"cticm: 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.
Dlstrlbutaxn: Part I White: facility copy
Part II Canary: Raleigh central office file copy
Part III Pink: Regional office file copy
Disposit1cm: 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.