2003-01-23
New York State Department of Environmental Conservation
Divisio~ of Solid and Hazardous Materials, 9th Floor
625 Broadway, Albany, New York 12233-7250
Phofl'e:- (518) 402-8651 . FAX: (518) 402-9024
Website: www.dec.state.ny.us
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Erin M. Crotty
Commissioner
Dear Facility Owner/Operator:
Re: Annual/Quarterly Reporting by Landfills, Landfill Gas Recovery Facilities, Waste-To-
Energy Facilities, Regulated Medical Waste Facilities, and Annual Reporting by
Construction & Demolition Debris Processing Facility, and Transfer Stations Regulated
Under Revised 6 NYCRR Part 360, November 21, 1998
Enclosed is a blank copy of the Annual/Quarterly Report form for your use in submitting your
referenced 2002 report.
Please note that the submission and completion of this form do not relieve you from any additional
reporting responsibilities that are identified as special conditions in your 6 NYCRR Part 360 operations
permit or that may be required for inactive (closed) facilities, recycling activities, or solid waste that is land
applied or composted.
One copv of each completed report should be submitted to the New York State Department of
Environmental Conservation (NYSDEC) Regional Office that has jurisdiction over your facility, and
one copy submitted to the NYSDEC, Division of Solid & Hazardous Materials, Bureau of Solid Waste
& Corrective Action, 625 Broadway, 9th Floor, Albany, New York 12233-7258.
Your completed Annual/Quarterly Reports for calendar year 2002 must be submitted no later than
60 calendar days after the first day of January (March 3, 2003).
Additional copies of these forms can be reproduced locally or are available upon request from each
NYSDEC Regional Office, The name, address and telephone number of the solid waste contact in each
Regional Office can be found on the last page of the report form.
Should you have any questions regarding the use of the enclosed form, please contact Gerard
Wagner, of our Bureau of Solid Waste & Corrective Action, at (518) 402-8694. Other questions regarding
your reporting responsibilities should be directed to your respective Regional Office.
Thank you for your cooperation in this matter.
Enclosures
Sincerely,
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5" ~~ ~ /'tCl>>A/V'- w ~_
Stephen Hammond, P .E.
Director r'\
Division of Solid & Hazardous Materif\E.CE,\\lE,1-l
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.1AN I :)
TOWN eLFP'
December 2002
, .
New York State Department of Environmental Conservation
Division of Solid & Hazardous Materials
Bureau of Solid Waste & Corrective Action
SOLID WASTE CONTACTS
CENTRAL OFFICE
Bureau of Solid Waste & Corrective Action
625 Broadway, 9th floor
Albany, NY 12233-7258
(518) 402-8694
REGIONAL OFFICE ADDRESS & LEAD CONTACT PERSON
REGION 1 (Nassau, Suffolk)
Anthony Cava
SUNY Campus
Loop Road, Building 40
Stony Brook, NY 11790-2356
(631) 444-0375
REGION 2 (Bronx, Kings, New York, Queens, Richmond)
Kenneth Brezner
1 Hunters Point Plaza
47-40 21st Street
Long Island City, NY 11101-5407
(718) 482-4996
REGION 3 (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester)
Paul John
21 South Putt Corners Road
New Paltz, NY 12561-1696
(845) 256-2127
REGION 4 (Albany, Columbia, Delaware, Greene, Montgomery, Otsego, Rensselaer,
Schenectady, Schoharie)
Dick Forgea
1150 North Westcott Road
Schenectady, NY 12306-2014
(518) 357-2045
Page 1 of 2
,
Rf~ION 5 (Clinton, Essex, Franklin, Fulton, Hamilton, Saratoga, Warren, Washington)
Main Office (Clinton, Essex,
Franklin, Hamilton)
Sub-office (Fulton, Saratoga, Warren,
Washington)
Dan Steenberge
Route 86, PO Box 296
Ray Brook, NY 12977-0296
(518) 897-1241
David Mt. Pleasant
Box 220
Hudson Street Extension
Warrensburg, NY 12885-0220
(518) 623-3671
REGION 6 (Herkimer, Jefferson, Lewis, Oneida, St. Lawrence)
Main Office (Jefferson, Lewis,
St. Lawrence)
Sub-office (Herkimer, Oneida)
John Kenna
State Office Building
317 Washington Street
Watertown, NY 13601-3787
(315) 785-2513
Robert Senior
State Office Building
207 Genesee Street
Utica, NY 13501-2885
(315) 793-2554
REGION 7 (Broome, Cayuga, Chenango, Cortland, Madison, Onondaga, Oswego, Tioga,
Tompkins)
Larry Gross
615 Erie Blvd. W.
Syracuse, NY 13204-2400
(315) 426-7419
REGION 8 (Chemung, Genesee, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca,
Steuben, Wayne, Yates)
Daniel David
6274 E. Avon-Lima Road
Avon, NY 14414-9519
(716) 226-2466
REGION 9 (Allegany, Catttaraugus, Chautauqua, Erie, Niagara, Wyoming)
Mark Hans
270 Michigan Avenue
Buffalo, NY 14203-2999
(716) 851-7220
Page 2 of 2
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TRANSFER STATION
Division of Solid & Hazardous Materials
New York State Department of Environmental Conservation
Albany, New York 12233-7258
TRANSFER STATION
Annual Report
Submit the Annual Report no later than 60 calendar days after the first
day of January following each year of operation.
Reporting of the information indicated on this Transfer Station Annual
Report form is required pursuant to 6 NYCRR 360-1.4(c); 360-1.8(e)(I)(ii),
(h)(8); 360-1.14(e) (2), (i)(I); 360-11.1(a), (b)(I)(viii); 360-11.4(h) and (j).
Failure to provide the required information requested is a violation of
Environmental Conservation Law. Timely submission of a properly completed form
to the Department's Regional Office that has jurisdiction over your facility and
to the Department's Central Office is required to meet the standard
Annual/Quarterly Report requirements of 6 NYCRR Part 360.
Where the standard Annual Report requirements have been modified,
appropriate Sections (as necessary to reflect the modification) must be
completed and submitted with a copy of the Department's written notification
which allows the modification.
Entries
in black ink.
supplementary
on the report forms should be either typewritten or neatly printed
Attach additional sheets if space on the pages is insufficient or
information is required or appropriate.
Please note that where reference is made to a "Quarter" such as in the
tabulations of Section 2, Quarter 1 is from January 1st to March 31st, Quarter 2
is from April 1st to June 30th, Quarter 3 is from July 1st to September 30th and
Quarter 4 is from October 1st to December 31st.
For purposes of estimating tonnage where only the volume is known, assume
each cubic yard of construction and demolition debris is equivalent to 0.75 tons
of solid waste, each cubic yard of compacted solid waste is equivalent to 0.5
tons, and each cubic yard of uncompacted solid waste is equivalent to 0.1 tons.
This form may be reproduced locally as required.
RECE\\IEO
FE.B 0 3 2003
TOWN CLERK
(Reprinted 12/02)
Page 1 of 6
TRANSFER STATION
Annual
This Transfer Station Annual Report
, 20 to
Report
is for the year of operation from
20
SECTION 1
Owner/Facility Information
Facility Name
Town
County
State Zip
Phone # (_____)_____
Fax # ( )
----- -----
NYSDEC Region #
Facility Location
Facility Contact
NYSDEC Facility Code or Registration #
Registered Facility Yes No
360 Permit #
/
Issued
/ /
Expires
/ /
Owner Name
Phone #
Mailing Address
State
Zip
SECTION 2
Quantity of Solid Waste Received
Report the tonnages of solid waste received on Table A.
unknown, indicate the cubic yards received on Table B.
If tonnages are
A. Tonnages were obtained by: Scale Weight
Estimated Other (Specify:
Truck Count
)
Type of Solid Waste Quarter Quarter Quarter Quarter Total
1 2 3 4
Mixed Municipal Solid Waste
(Residential, Institutional &
Commercial)
Construction & Demolition
(C&D) Debris
Asbestos Waste
Industrial Waste (Including
Industrial Process Sludges)
Other (Specify:
)
Total Tons Received
(Reprinted 12/02)
Page 2 of 6
TRANSFER STATION
B. Cubic yards were obtained by:
Other (Specify:
Truck Count
Estimated
)
Type of Solid Waste Quarter Quarter Quarter Quarter Total
1 2 3 4
Mixed Municipal Solid Waste
(Residential, Institutional &
Commercial)
Construction & Demolition
(C&D) Debris
Asbestos Waste
Industrial Waste (Including
Industrial Process Sludges)
Other (Specify:
)
Total Cubic Yards Received
Facility's Service Area
Identify the facility's service area by indicating the type of solid waste
received, and the (county, state) or (province, country) from where waste
received originates.
Transport (check all that apply):
Road
Rail
Water
Other
Type of Solid Waste
County or Province
State or Country
Tons
Transfer or Disposal Destination
Identify the transfer or disposal destination of waste removed by indicating the
name of the transfer or disposal facility, the type of solid waste transferred,
the (county, state) or (province, country) of transfer or disposal, and the
amount transferred or disposed at each disposal destination.
Transport (check all that apply)
Road
Rail
Water
Other
Transfer/
Disposal Facility
Type of
Solid Waste
County
or Province
State
or Country
Tons
(Reprinted 12/02)
Page 3 of 6
TRANSFER STATION
SECTION 3
Material Recovered
For each type of solid waste recovered, provide the annual weight in tons or, if
any tonnages are unknown, the annual volume in cubic yards, and indicate the
destination.
Tonnages or cubic yards were obtained by:
Estimated Other (Specify:
Scale Weight
Truck Count
)
Type of Solid Waste Weight Volume Destination
Recovered (tons/year) (cubic yards/year)
Aggregate & Concrete
Wood & Wood Chips
Glass
Plastic
Paper
Metal Containers
Bulk Metal
Other (Specify:_
)
Total Recovered
Is the transfer station authorized to handle recyclable material?
Yes
No
Is the transfer station authorized to process construction and demolition (C&D)
debris? Yes No
SECTION 4
Unauthorized Solid Waste
Has unauthorized solid waste been received at the transfer station during t~e
reporting period?
Yes No
If yes, give information below for each incident:
Date Received Type Received Date Disposed Disposal Method & Location
(Reprinted 12/02)
Page 4 of 6
TRANSFER STATION
SECTION 5
Problems
Identify any problems encountered during the reporting period (e.g. specific
occurrences which have led to changes in facility procedures) and methods for
resolution of the problems. List submissions (required by this section) that
have been attached to this form or the reasons for not attaching a required
piece of information:
SECTION 6
Chanqes
Identify any changes in the operatio~ that have occurred during the reporting
period (e.g. equipment, service area, and operational procedure changes). List
submissions (required by this section) that have been attached to this form or
the reasons for not attaching a required piece of information:
SECTION 7
Permit/Consent Order/Reqistration Reportinq Requirements
Are there any additional permit/consent order/registration reporting
requirements not covered by the pievious sections of this form? Yes No
If yes, identify the reporting requirements with their respective responses
below, attaching additional sheets as necessary. List submissions (required by
this section) that have been attached to this form or the reasons for not
attaching a required piece of information:
SECTION 8
Tippinq Fee (To Be Optionallv Provided)
Tipping Fee:
$/ton
For each type of waste below, indicate the tipping fee if different:
Mixed Municipal Solid Waste (Residential, Institutional & Commercial)
Construction & Demolition (C&D) Debris
Asbestos Waste
Industrial Waste (Including Industrial Process Sludges)
Other (Specify:
$/ton
$/ton
$/ton
$/ton
S/ton
(Reprinted 12/02)
Page 5 of 6
TRANSFER STATION
.
SECTION 9
Siqnature and Date bv Owner or Operator
NOTE: Owner or Operator must sign, date and submit one completed form, each
with an original signature to:
New York State Department of Environmental Conservation
Division of Solid & Hazardous Materials
Bureau of Solid Waste & Corrective Action
625 Broadway
Albany, New York 12233-7258
and one copy with an original
Office. (See attachment for
Contacts. )
signature
Regional
to the
Office
appropriate NYSDEC Regional
addresses and Solid Waste
I hereby swear or affirm that information provided on this form and attached
statements and exhibits is true to the best of my knowledge and belief.
Date
Signature
Name (Print or Type)
Title (Print or Type)
City
Address
State and Zip
-)-
Phone Number
ATTACHMENTS: Yes No
- -
(Please check appropriate line)
(Reprinted 12/02)
Page 6 of 6