8702T_SwainCounty_Trans_AFR14-15

TRANSFER STATION
Facility Annual Report
For the period ofJuly 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.Ifyou have questions or require assistance in completing this report,contact
your Regional Environmental Senior Specialist.
Facility Name:'-£TJlAlJ <T fe/2.Permit:
Street 1:
Street 2:
City:County:<A
Street 1:^Q
Street 2:
City:/Zt C(\/
State:North Carolina State:North Carolina p=2*7/3
^
Name:
Phone:
Email:
Fax:-6't/1>3
Name:
Phone:
Email:
I
Fax:
1.Tipping Fee:$/e*<<•u/per Ton (Attach a schedule of tipping fees ifappropriate.)
Does the tip fee above include the $2.00 Solid Waste Tax?0*^es fj No
2.Did your facility stop receiving waste during this past Fiscal Year?
If so,please report the date this occurred:
Yes
Yes □No3.Are there SWANA or other certified operator(s)at this facility?
Ifyes,indicate the following:
Name:*4j»^#-tTI ,y>»Certification type and expiration date:H
Name:
Name:
V»,j u r\Certification type and expiration date:
Certification type and expiration date:
~/^"~JLfi
4.What other activities occur at this facility?(check all that apply)
QJ'Recycling/Reuse Collection fj Scrap Tire Collection fj White Goods Collection fj Household Hazardous Waste Collection
Ifyou checked Recycling/Reuse Collection,please indicate the materials accepted and amount collected:(check all that apply and provide tonnages)
Q Carpet tons FJ Concrete/rubble/asphalt tons FJ]Gypsum/drywall tons [Toother Metal tons
"Cardboard tons Q Shingles tons r7^Eiectronics tons pfother Plastic
Wood tons
Shingles
Other (specify)
tons
5.If required to file NC E-500K forms with NC Dept.of Revenue,provide the four quarterly tonnages this facility reported for fiscal year
2014-2015.
July 1 -September 30
October 1 -December 31
January 1 -March 31
April 1 -June 30
Total
I-2.
n,
.&D
:■■:■■:*.■■■■■;■...
'6.Total waste received (INCLUDING WASTE TRANSFERRED AND RECYCLED)at this facility during the period ofJuly 1.2014.
through June 30.2015.Indicate tonnage received by COUNTY ofwaste 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
721 J$7S3.7s .gp
22t>7 IZH)13.33 13.3*4
ijOCiA
53o
LOtft rr\i ftiM-by.8.&1
i.37 1.56 3.95
t.56
fkshn
35 9,7t>bit
372*39
,67
10
Ccloc 23 J/33,3'
76%
7.Indicate the facility(s)that received your facility's transferred waste material:Grand Total
GO
#-On 9 O
\\J,
TOTAL
Please return your completed report to:
CERTIFICATION^1 certify that the information provided is an accurate representation ofthe activity at this facility.
Signature:s(\/*f)XT ^\...^>i mJ Date:
Name:H 7U £fiW Title:Q i
Phone Number:$O£~t/£&-rf7/tf Email:&AXK*JS*Wf\\+JtfC ,Col/
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