West Virginia Code of State Rules › Agency 33 - Waste Management, Division Of Water And Waste Management › Title 33 - LEGISLATIVE RULE DEPARTMENT OF ENVIRONMENTAL PROTECTION WASTE MANAGEMENT › Series 33-06 - Solid Waste Assessment Fee Exemptions › Appendix A

Current through Register Vol. XLI, No. 28, July 12, 2024
WEST VIRGINIA DIVISION OF ENVIRONMENTAL
				  PROTECTION
SOLID WASTE ASSESSMENT FEE EXEMPTION
				  APPLICATION
PLEASE COMPLETE AND RETURN TO:
W. Va. Division of Environmental Protection
Assessment Fee Exemption
1356 Hansford Street
Charleston, WV 25301
1. NAME, ADDRESS, AND TELEPHONE NUMBER OF APPLICANT:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Please indicate whether you are the:
( )Facility owner,
( )Facility operator,
( )Facility lessee,
( )Person delivering his or her waste to a resource recovery;
				  or
( )Recycling facility.
2. LOCATION OF THE FACILITY AND ITS PERMIT NUMBER:
_____________________________________________________
_____________________________________________________
3. BRIEF DESCRIPTION OF THE TYPE AND ESTIMATED ANNUAL AMOUNT
				  OF WASTE DISPOSED AT THIS FACILITY:
_____________________________________________________
_____________________________________________________
_____________________________________________________
4. BRIEF DESCRIPTION OF THE BUSINESSES OR ACTIVITIES WHICH
				  GENERATE THE WASTE DISPOSED AT THIS FACILITY:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
NOTE: If you are seeking an exemption for a facility that
				  disposes of waste on a cost-sharing or nonprofit basis, please complete item 5.
				  If you are seeking an exemption for reuse or recycling, please complete item
				  6.
5. BRIEF SUMMARY OF THE LEGAL DOCUMENTS WHICH DESCRIBE THE
				  RELATIONSHIP BETWEEN YOUR FACILITY AND THE INDIVIDUALS DISPOSING WASTE THERE ON
				  A COST-SHARING OR NONPROFIT BASIS:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Please attach an additional sheet listing the name, address,
				  and telephone number of each person using the facility on a cost-sharing or
				  nonprofit basis.
6. BRIEF DESCRIPTION OF THE PROCESS OR METHOD EMPLOYED TO
				  REUSE OR RECYCLE YOUR DELIVERED WASTE:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Please attach a notarized statement from the facility owner
				  or operator that certifies that a reuse or recycling process is in operation at
				  his or her facility and that the delivered waste will in fact be reused or
				  recycled.
I hereby declare that the information in this application is
				  accurate and true to the best of my knowledge and belief. I understand that the
				  filing of false, inaccurate, or misleading information is grounds for the
				  revocation of my exemption.
______________________ _____________________
Signature of Applicant Date