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HomeMy WebLinkAbout5202_MaysvilleRecycling_20170701_FAR16-17T&P 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. Indicate types of waste processed at this facility. (Check all that apply) Medical Waste Construction and Demolition Waste Household Hazardous Waste Landclearing and inert debris (LCID) Yard WasteIndustrial Waste Other (describe) 4. Indicate types of processes occurring at this facility. (Check all that apply) Grinding, composting or mulching Medical Waste treatment Incineration Recycling/Reuse Collection (if yes, indicate materials collected; check all that apply and provide tonnages) Other activities (specify) 2. Did your facility stop receiving waste during this past Fiscal Year? Yes No If so, please report the date this occurred: TREAT & PROCESS State of North Carolina Department of Environmental Quality Division of Waste Management TREATMENT & PROCESSING FACILITY 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. 5. Indicate the type and quantity of material from recycling or recovery operations stockpiled on-site as of June 30, 2017 (e.g. Wood-3 tons, Metal-5 tons, Cardboard-2 tons, etc.). Carpet tons Wood tons Concrete/rubble/asphalt tons Gypsum/drywall tons Cardboard tons Electronics tons Other Metal tons Other Plastic tonsShinglestons Other (specify) T&P 2017 Page 2 6. Total waste received at this facility during the period of July 1, 2016 through June 30, 2017. Indicate tonnage received by COUNTY of waste origin. If waste was received from a transfer station,treatment and processing, or mixed waste processing facility indicate the COUNTY LOCATION OF THE FACILITY. Please list ALL counties from which you received waste. 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: 7. Indicate the facility(s) that received your facility's non-recycled waste material: NAME, PERMIT #, and LOCATION (city, state) of FACILITY Tons TOTAL Facility Type 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: