Transfer Station Name: __________________________________________
Transfer Station Number: ________________________________________
Transfer Station Operator: ________________________________________
From: ________________________________ Reporting Period:
To: Delaware Solid Waste Authority Date:
TYPE OF WASTE | TONS RECEIVED | TONS DISPOSED | DISPOSAL FACILITY Tons Location (Name and 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. E