Department of Energy & Environmental Protection Bureau of Materials Management & Compliance Assurance 79 Elm Street - 4th Floor Hartford, CT Commercial GP Facility Receiving Non-RCRA Hazardous Waste and Compatible Solid Wastes (APPENDIX E WASTES) - Quarterly Solid Waste (SW) Reporting Form Name of Facility: Permittee: SW Permit #: Facility Location: Street: Town: State: Zip Code: `Phone: Mailing Address (if different from facility location): Facility-Commercial GP Authorized Appendices Appendix A; Appendix B; Appendix C; Appendix D; Appendix E; – Appendix F; Appendix G If this facility is authorized for more than one SW facility category Materials authorized in more than one facility – category must only be reported ONCE on ONE reporting form. Receipt and storage capacities are NOT cumulative. Does the facility have a scale? Yes No If Non-RCRA and Compatible Wastes are not weighed – Please describe method for estimating weight. Reporting Quarter YEAR: QUARTER: APPENDIX E COMMERCIAL GP FACILITY Part 1 Non-RCRA Hazardous Waste and Compatible Solid Wastes Received – Part 1A Non-RCRA Hazardous Waste and Compatible Solid Wastes Received from a CT – REGIONAL SW FACILITY ORIGIN TYPE OF SOLID WASTE RECEIVED QUARTER TOTAL NAME/LOCATION OF CT REGIONAL SW FACILITY from which Tons Received Non-RCRA and Compatible Wastes were RECEIVED Select from: Dropdown: Other Specify – Select from: Dropdown: Other Specify – Select from: Dropdown: Other Specify – Select from: Dropdown: Specify – Select from: Dropdown: Other Specify – Select from: Dropdown: Specify – Select from: Dropdown: Other Specify – Part 1B Non-RCRA Hazardous Waste and Compatible Solid Wastes Received DIRECT HAUL – FROM CONNECTICUT GENERATORS or from CT MUNICIPAL TRANSFER STATIONS (But not from regional solid waste facilities) ORIGIN TYPE OF SOLID WASTE RECEIVED QUARTER TOTAL Tons Received CT Direct Haul or from a CT Municipal TS Select from: Dropdown: CONNECTICUT Other Specify – Select from: Dropdown: CONNECTICUT Other Specify – Select from: Dropdown: CONNECTICUT Other Specify –
Department of Energy & Environmental Protection Bureau of Materials Management & Compliance Assurance 79 Elm Street - 4th Floor Hartford, CT Commercial GP Facility Receiving Non-RCRA Hazardous Waste and Compatible Solid Wastes (APPENDIX E WASTES) - Quarterly Solid Waste (SW) Reporting Form Name of Facility: Permittee: SW Permit #: Facility Location: Street: Town: State: Zip Code: `Phone: Mailing Address (if different from facility location): Facility-Commercial GP Authorized Appendices – Appendix A; Appendix B; Appendix C; Appendix D; Appendix E; Appendix F; Appendix G If this facility is authorized for more than one SW facility category – Materials authorized in more than one facility category must only be reported ONCE on ONE reporting form. Receipt and storage capacities are NOT cumulative. Does the facility have a scale? Yes No If Non-RCRA and Compatible Wastes are not weighed – Please describe method for estimating weight. Reporting Quarter YEAR: QUARTER: APPENDIX E COMMERCIAL GP FACILITY Part 1 – Non-RCRA Hazardous Waste and Compatible Solid Wastes Received Part 1A – Non-RCRA Hazardous Waste and Compatible Solid Wastes Received from a CT REGIONAL SW FACILITY ORIGIN NAME/LOCATION OF CT REGIONAL SW FACILITY from which Non-RCRA and Compatible Wastes were RECEIVED TYPE OF SOLID WASTE RECEIVED QUARTER TOTAL Tons Received Select from: Dropdown: Other – Specify Select from: Dropdown: Other – Specify Select from: Dropdown: Other – Specify Select from: Dropdown: – Specify Select from: Dropdown: Other – Specify Select from: Dropdown: – Specify Select from: Dropdown: Other – Specify Part 1B – Non-RCRA Hazardous Waste and Compatible Solid Wastes Received DIRECT HAUL FROM CONNECTICUT GENERATORS or from CT MUNICIPAL TRANSFER STATIONS (But not from regional solid waste facilities) ORIGIN CT Direct Haul or from a CT Municipal TS TYPE OF SOLID WASTE RECEIVED QUARTER TOTAL Tons Received CONNECTICUT Select from: Dropdown: Other – Specify CONNECTICUT Select from: Dropdown: Other – Specify CONNECTICUT Select from: Dropdown: Other – Specify