Del. Admin. Code tit. 1, 500, 501, att. B

Current through Register Vol. 28, No. 5, November 1, 2024

Attachment B

SOLID WASTE HAULER REPORT FOR WASTE GENERATED IN DELAWARE AND DELIVERED AND/OR DISPOSED AT OTHER THAN DSWA FACILITY

From: ______________________________ Reporting Period: ____________________________________

To: Delaware Solid Waste Authority Date: _____________________________________________

TYPE OF WASTE	TONS RECEIVED	TONS DISPOSED	DISPOSAL FACILITY Tons Location Name Address
SOLID WASTE
a. Delaware	1.
2.
3.
4.
b. Other	1.
2.
3.
4.
TOTAL
SPECIAL SOLID WASTE
a. Delaware	1.
2.
3.
4.
b. Other	1.
2.
3.
4.
TOTAL
DRY WASTE
a. Delaware	1.
2.
3.
4.
B. Other	1.
2.
3.
4.
TOTAL
GRAND TOTAL

CERTIFICATION I hereby certify that the above information is true and correct, to the best of my knowledge, this

day of, A.D. 20.

___________________________ _________________________

Notary Public Signature Owner's Representative

Notary Public Printed Name Owners Representative Printed Name and Title:

Del. Admin. Code tit. 1, 500, 501, att. B

17 DE Reg. 313 (9/1/2013)(Final)