7202T_PerquimansChowanGates_20140904_AFR13-14

Transfer2014 Page 1 7202T-Transfer 1995
Facility Name:Perquimans Chowan Gates Transfer Station Permit: 7202T-Transfer 1995
Physical Address
Street 1: 759 Perry's Bridge Rd.
Street 2:
City: Belvidere
State:North Carolina Zip: 27919
County: Perquimans
Mailing Address
Street 1: PO Box 189
Street 2:
City: Elizabeth City
State:North Carolina Zip: 27907-0189
Primary Facility Contact Person
Name: Brad Gardner
Phone: [phone] Fax: [phone]
Email:[e-mail]
Billing Contact Person
Name: Laurie Jeffries
Phone: [phone] Fax: [phone]
Email: [e-mail]
1. Tipping Fee: $67.00 per Ton (Attach a schedule of tipping fees if appropriate.)
3. Are there SWANA or other certified operator(s) at this facility?Yes No
If yes, indicate the following:
Name: Horace Griffin
Certification type and expiration date: TS 12-06-16
Name: Charlie Rome
Certification type and expiration date: TS 5-09-17
Name: David Lowe
Certification type and expiration date: TS 3-12-16
2. Did your facility stop receiving waste during this past Fiscal Year? Yes No
If so, please report the date this occurred:
Does the tip fee above include the $2.00 Solid Waste Tax?Yes No
TRANS State of North Carolina
Department of Environment and Natural Resources
Division of Waste Management
TRANSFER STATION
Facility Annual Report
For the period of July 1, 2013-June 30, 2014
According to (G.S. 130A-309.09D(b)) completed forms must be returned by August 1, 2014 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.
4. What other activities occur at this facility? (check all that apply)
Scrap Tire Collection White Goods Collection Household Hazardous Waste CollectionRecycling/Reuse Collection
If you checked Recycling/Reuse Collection, please indicate the materials accepted and amount collected: (check all that apply and provide tonnages)
Carpet tons
Wood tons
Concrete/rubble/asphalt tons Gypsum/drywall tons
Cardboard tons Electronics tons
Other Metal tons
Other Plastic tonsShinglestons
Other (specify)
5. Provide the four quarterly tonnages this facility reported on NC E-500K forms between July 1, 2013 and June 30, 2014:
Quarter Tons Reported
July 1 - September 30
October 1 - December 31
January 1 - March 31
April 1 - June 30
Total
Transfer2014 Page 2 7202T-Transfer 1995
6. Total waste received (INCLUDING WASTE TRANSFERRED AND RECYCLED) at this facility during the period of July 1, 2013,
through June 30, 2014. Indicate tonnage 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
Perquimans 572.73 670.58 524.45 561.56 509.2 530.48 484.23 420.62 543.37 658.72 698.02 755.99 6,929.95
Chowan 469.34 368.12 323.82 363.22 300.5 474.42 385.14 306.82 349.92 385.6 520.6 373.44 4,620.94
Gates 339.98 376.04 329.83 347.45 305.74 407.07 297.72 341.23 391.28 354.82 404.69 364.33 4,260.18
Grand Total 15,811.077. Indicate the facility(s) that received your facility's transferred waste material:
NAME, PERMIT #, and LOCATION (city, state) of FACILITY Tons
East Carolina Environmental Landfill, Permit # 08-03, Aulander, NC MSW Landfill 15,811.07
TOTAL 15,811.07
Facility Type
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility.
Signature:Date: Jul 16, 2014
Name: Brad Gardner
Phone Number: [phone] Email:[e-mail]
Title: PCG Landfill Commission Supervisor
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:
Ben Barnes
PO Box 8998
Rocky Mount, NC 27804-6998
phone: [phone] email: [e-mail]
Bradley J. Gardner Digitally signed by Bradley J. Gardner DN: cn=Bradley J. Gardner, o=Perquimans, Chowan and Gates Landfill, ou=PCG Landfill, email=[e-mail], c=US Date: 2014.07.16 10:37:07 -04'00'