City State Zip Telephone Number 1. and Quantities of All SW Managed by the Facility # Unit Name (as named by the facility and referenced in permit ) Type(s) Unit Type (MUST USE ONE OF THE FOLLOWING: Air Curtain Destructor, Autoclave, Compost Facility, C&D Debris Landfill, Incinerator, Landfarm, Landfill , Processing Transfer Station, Refuse-Derived Fuel, Resource Recovery/Recycling, Separation Facility, Shredder/Compactor Baler, Surface Impoundment, Woodwaste Landfill) STATUS TYPE I TYPE II TYPE I-A TYPE II-A TYPE III Operating 1 2 3 4 5 6 7 8 9 0 2. Facility-Wide Solid Waste Management A. Did the facility generate solid waste? Yes If “yes,” complete Attachment 1, the types and quantities, in wet tons, of solid waste generated, including waste generated but sent off-site for disposal. No B. Did the facility process solid waste? Yes If “yes,” complete Attachment 2, the and quantities, in wet tons, of solid waste processed, including waste generated on-site and off-site, indicating percentage of each. For waste generated off-site, indicate whether the waste was generated in-state or out-of-state. No C. Did the facility dispose solid waste in a permitted unit? Yes If “yes,” complete Attachment 3 with the types and quantities, in wet tons, of solid waste disposed, including waste generated on-site and off-site, indicating percentage of each. For waste generated off-site, indicate whether the waste was generated in-state or out-of-state. ALSO COMPLETE ITEM 2.C.1 BELOW. No 1. Did any permitted landfill receive construction and demolition debris (C&D) for disposal? Yes If “yes,” the “Construction & Demolition Debris” portion of Attachment 3 must be completed. No
Attachment 5 Off-Site Reuse and/or Recycling Complete this attachment if the facility sent materials off-site for reuse and/or recycling. Provide a summary of product use. the code that applies from the table below or the name of the material shipped off-site for recycling/re-use (in wet tons ONLY). Enter the name of the person receiving the material for reuse, recycling, or resale. Also, enter the mailing address, name of a contact person and the telephone number. All calculations used to compute the quantity (expressed in wet tons) of solid waste generated at the facility must be documented by the facility and kept as part of the operating record. Quantity of Material Shipped Off-Site (Wet Tons) Persons Receiving Material Shipped Off-Site for Code/Name Quantity Recycled Quantity Re-used Name: Mailing Address: Contact Person: Telephone: Received for: Reuse Recycling Quantity of Material Shipped Off-Site (Wet Tons) Persons Receiving Material Shipped Off-Site for Reuse/Recycling Code/Name Quantity Recycled Quantity Re-used Name: Mailing Address: Contact Person: Telephone: Received for: Recycling Quantity of Material Shipped Off-Site (Wet Tons) Persons Receiving Material Shipped Off-Site for Reuse/Recycling Code/Name Quantity Recycled Quantity Re-used Name: Mailing Address: Contact Person: Telephone: Received for: Recycling MATERIAL CODES SEPARATION FACILITIES COMPOSTING FACILITIES 01-A Glass M1 Class M1 Compost 01-B Metals M2 Class MC Compost 01-C Paper S1 Class S1 Compost 01-D Plastic S2 Class S2 Compost 01-E Goods YW Class YW Compost 01-F Batteries 01-G Waste Oil 01-H Other, Specify
Attachment 8 Removal of Solids/Sludges from Surface Impoundments Complete this attachment if solids/sludges were removed from a surface impoundment and disposed either on-site or off-site during this reporting period. Provide the amount of (solids/sludge) sent for disposal during the reporting period (in wet tons ONLY), enter the disposer's identification number, and permit number and agency interest number assigned by the Department of Environmental Quality. Enter the transporter’s identification number assigned by the Department of Environmental Quality. Add up the amounts reported and enter in the TOTAL box. Enter the percentage of waste disposed on-site and off-site. Name of the surface impoundment: QUANTITY OF WASTE REMOVED FROM SURFACE IMPOUNDMENT (WET TONS) TRANSPORTER ID # DISPOSER SW ID # DISPOSER PERMIT # DISPOSER AI # TOTAL % of Waste Disposed On-Site: % of Waste Disposed Off-Site: Name of the surface impoundment: QUANTITY OF WASTE REMOVED FROM SURFACE IMPOUNDMENT (WET TONS) TRANSPORTER ID # DISPOSER SW ID # DISPOSER PERMIT # DISPOSER AI # % of Waste Disposed On-Site: % of Disposed Off-Site: Name of the surface impoundment: QUANTITY OF REMOVED FROM SURFACE IMPOUNDMENT (WET TONS) TRANSPORTER ID # DISPOSER SW ID # DISPOSER PERMIT # DISPOSER AI # TOTAL % of Waste Disposed On-Site: % of Waste Disposed Off-Site: