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HomeMy WebLinkAbout9218_NorthWakeHHW_20180701_AFR17-18HHW 2018 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. 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 Other Mercury-Containing Material Electronic Material Flammable Solids Oxidizing Material Poisonous Material Flammable Liquids Corrosive Material Batteries Compressed Gases Antifreeze, Used Oil, Filters Paint, Latex Paint, Alkyd Other: Other: Other: Total Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds HHW State of North Carolina Department of Environmental Quality Division of Waste Management HOUSEHOLD HAZARDOUS WASTE COLLECTION Facility Annual Report For the period of July 1, 2017-June 30, 2018 According to G.S. 130A-309.09D(b), completed forms must be returned by August 1, 2018, 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. 1. Did your facility stop receiving waste during this past Fiscal Year? Yes No If so, please report the date this occurred: HHW 2018 Page 2 3. Total household hazardous waste receive at this facility during the period of July 1, 2017, through June 30, 2018. Indicate in Pounds amount received by COUNTY of waste origin. Please indicate COUNTY and STATE, if received from another state. Received from Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 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 certified operator(s) employed at this facility? If yes, indicate the following:Yes No Certification type and expiration date: Name: Name: Certification type and expiration date: Total from #2:Difference between #2 and #3: 4. Number of participants who delivered materials to the HHW facility: 5. Does your facility accept waste from conditionally exempt small quantity generators (CESQG)? Yes No If yes, do you charge for CESQG waste?Yes No Reason for Difference between #2 and #3: