4410-COMPOST--FY16-17

Compost 2017 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:
1. Tipping Fee: $per Ton (Attach a schedule of tipping fees if appropriate.)
3. Please attach results of monthly temperature monitoring for the period of July 1, 2016 thru June 30, 2017.
4. For Type II, III, and IV facilities, attach results of tests (Waste Analysis with metals, foreign matter and pathogens) as required in Table 3 of
Rule 15A NCAC 13B .1408 for the period of July 1, 2016 thru June 30, 2017. Current Rules state that "Compost shall be analyzed at
intervals of every 20,000 tons of compost produced or every six months, whichever comes first."
5. What type and quantity of waste was composted by your facility?
Materials COMPOSTED Check X if Received Tons RECEIVED Tons COMPOSTED
Unusable Tons
DISPOSED
Yard Waste
Clean Wood
Sawdust
Wooden Pallets
Food Waste
Animal Waste
Sludge and Biosolids
Grease Trap Waste
Animal Mortalities
Sheetrock
Commingled
(Describe)
Other
(Describe)
Other
(Describe)
Other
(Describe)
TOTAL
Compost State of North Carolina
Department of Environmental Quality
Division of Waste Management
COMPOST
Facility Annual Report
For the period of July 1, 2016-June 30, 2017
According to G.S. 130A-309.09D(b), completed forms must be returned by August 1, 2017 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.
2. Did your facility stop receiving waste during this past Fiscal Year? Yes No
If so, please report the date this occurred:
Compost 2017 Page 2
6. What type and quantity of compost was produced and removed from your facility?
Type
Tons
CREATED
Tons USED
On Site
Tons SOLD
to Public
Tons GIVEN
to Public
Tons
STOCKPILED
Tons
DISPOSED
Other
Mulch
Grade A Compost
Grade B Compost
Other
Other
TOTAL
7. Indicate waste received at this compost facility during the period of July 1, 2016, through June 30, 2017. 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
Grand Total
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility.
Signature:Date:
Name:
Phone Number:Email:
Title:
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 send your completed report to: