1904TP_ChathamCounty_HHW_AFR14-15

HHW 2015 Page 1
Facility Name:Permit:
Physical Address
Street 1:
Street 2:
City:
State:Zip:
County:
Mailing Address
Street 1:
Street 2:
City:
State:Zip:
Primary Facility Contact Person
Name:
Phone:Fax:
Email:
Billing Contact Person
Name:
Phone:Fax:
Email:
2. Number of participants who delivered materials to the HHW facility:
4. Indicate type and quantity of material accepted for treatment and its destination.
Material Quantity (pounds or gallons)Treatment
Destination or Contractor responsible for
disposal (company and state)
Fluorescent Lightbulbs Pounds
Gallons
Other Mercury-Containing
Material
Pounds
Gallons
Electronic Material Pounds
Gallons
Flammable Solids Gallons
Pounds
Oxidizing Material Pounds
Gallons
Poisonous Material Pounds
Gallons
Flammable Liquids Pounds
Gallons
Corrosive Material Pounds
Gallons
Batteries Pounds
Gallons
Compressed Gases Pounds
Gallons
Paint, Latex Pounds
Gallons
Paint, Alkyd Pounds
Gallons
Other:Pounds
Gallons
Other:Pounds
Gallons
HHW State of North Carolina
Department of Environment and Natural Resources
Division of Waste Management
HOUSEHOLD HAZARDOUS WASTE
COLLECTION
Facility Annual Report
For the period of July 1, 2014-June 30, 2015
According to (G.S. 130A-309.09D(b)) completed forms must be returned by August 1, 2015 and a copy of this report must be sent to the
County Manager of each county from which waste was received. If you have questions or require assistance in completing this report, contact
your Regional Environmental Senior Specialist.
Antifreeze, Used Oil, Filters Pounds
Gallons
1. Did your facility stop receiving waste during this past Fiscal Year? Yes No
If so, please report the date this occurred:
3. Does your facility accept waste from conditionally exempt small quantity generators (CESQG)? Yes No
If yes, do you charge for CESQG waste?Yes No
1904TP-HHW-
Chatham County 1904TP-HHW-
39 County Services Rd
Pittsboro
North Carolina 27312
Chatham
PO Box 1550
Pittsboro
North Carolina 27312
Sandy Skolochenko
[phone] [phone]
[e-mail]
same
781.00
612.00 3. Prepared for recycling ECOFLO - NC
25.00 3. Prepared for recycling ECOFLO - NC
Select...
Select...
900.00 5. Prepared for disposal ECOFLO - NC
3,240.00 5. Prepared for disposal ECOFLO - NC
8,894.00 4. Prepared for energy use ECOFLO - NC
1,200.00 5. Prepared for disposal ECOFLO - NC
1,381.00 3. Prepared for recycling ECOFLO - NC
2,164.00 1. Recycled Locally ECOFLO - NC
36,560.00 3. Prepared for recycling ECOFLO - NC
11,255.00 4. Prepared for energy use ECOFLO - NC
Non-HAZ 9,080.00 5. Prepared for disposal ECOFLO - NC
Select...
Select...
HHW 2015 Page 2
5. Total household hazardous waste receive at this facility during the period of July 1, 2014, through June 30, 2015. Indicate in pounds
amount received by COUNTY of waste origin. Please indicate COUNTY and STATE, if received from another state.
Received from
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Total
Grand Total
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility.
Signature:Date:
Name:Title:
Phone Number:Email:
REMINDER: According to (G.S. 130A-309.09D(b)), this
report must be sent to the Regional Environmental Senior
Specialist for your area and a copy of this report must be
sent to the County Manager of each county from which
waste was received.
Please return your completed report to:
6. Are there SWANA or other certified operator(s) at this facility?Yes No
If yes, indicate the following:
Name:
Certification type and expiration date:
Name:
Certification type and expiration date:
Name:
Certification type and expiration date:
Name:Certification type and expiration date:
Name:Certification type and expiration date:
1904TP-HHW-
Chatham County 15,850 17,830 9,861 14,837 16,933 75,311
75,311
Dan J. LaMontagne, PE Digitally signed by Dan J. LaMontagne, PE
DN: cn=Dan J. LaMontagne, PE, o, ou, email=[e-mail], c=US
Date: 2015.07.29 07:54:27 -04'00'Jul 28, 2015
Dan LaMontagne, PE Public Works Director
[phone] [e-mail]
John Patrone
PO Box 5123
High Point, NC 27262
phone: [phone] email: [e-mail]
HAZWOPER, Jan 2016Juan Balbuena