Instructions for the Kentucky Notification of



Kentucky Department for Environmental Protection Division of Waste ManagementRecycling and Local Assistance Branch300 Sower Boulevard, Second Floor – Frankfort KY 40601(502) 564-6716Illegal Open Dump Cleanup Grant Program Final Expense WorksheetFOR OFFICIAL USE ONLY.DO NOT WRITE IN THIS SPACE1. Grant Year FORMTEXT ?????2. County FORMTEXT ?????3. Date(s) Cleaned FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???, FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???4. Dumpsite Name FORMTEXT ?????5. Agency Interest Number (Tempo ID) FORMTEXT ?????6. COUNTY CLEANUP COSTS6(a). County Equipment CostsEquipment TypeFunding Source (DWM Dump Grant, County, Other Grants, or In-Kind Expenses)Actual Hourly Rate (Not to exceed Maximum Allowable Hourly Rate)Hours UsedTotalBulldozer, 200-269 h.p. FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Bulldozer, 140-199 h.p. FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Bulldozer, 120-139 h.p. FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Bulldozer, 100-119 h.p. FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Bulldozer, 50-99 h.p. FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Skid Steer (Bobcat) FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Rubber Tired Backhoe FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Crawler-Mounted Backhoe FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Excavator FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Track Loader FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Farm Tractor FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Dump Truck, Single FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Dump Truck, Double-Axle FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Dump Truck, Triple Axle FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Pickup, 2 Wheel Drive FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Pickup, 4 Wheel Drive FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Crew cab, 2 Wheel Drive FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Crew cab, 4 Wheel Drive FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Passenger Van FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Roll-off FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Other (specify): FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????Other (specify): FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????County Equipment Costs Subtotal$ FORMTEXT ?????6(b). County Disposal and Recycling CostsFacility Name & LocationFunding SourceTons Disposed or RecycledPer Ton CostTotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????County Disposal and Recycle Costs Subtotal$ FORMTEXT ?????6(c). County Labor CostsEmployee Name & TitleFunding SourceActual Hours WorkedHourly WageTotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????County Labor Costs Subtotal$ FORMTEXT ?????6(d). County Miscellaneous Supplies CostsSpecific ItemFunding SourceQuantityPer Unit CostTotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ???$ FORMTEXT ?????County Miscellaneous Supplies Costs Subtotal$ FORMTEXT ?????6(e). Total County Cleanup Costs. Subtotal the costs from Sections 6(a) through 6(d).$ FORMTEXT ?????7. PROJECT COST SUMMARY7(a). Total County Cleanup Costs. Enter amount from Section 6(e) of this form.$ FORMTEXT ?????7(b). Total Contractor Cleanup Costs. Enter amount from Contractor Cost Sheet, Section 9(e) of this form.$ FORMTEXT ?????7(c). Grand Total. Total Sections 7(a) and 7(b) of form.$ FORMTEXT ?????8. Report PreparationName: FORMTEXT ?????Signature: FORMTEXT ????? Date: FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ??? Email Address: FORMTEXT ?????Phone Number: ( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????9. CONTRACTOR CLEANUP COSTS9(a). Contractor Equipment CostsEquipment TypeActual Hourly RateHours UsedTotal FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????Contractor Equipment Costs Subtotal$ FORMTEXT ?????9(b). Contractor Disposal and Recycling CostsFacility Name & LocationTons Disposed or RecycledPer Ton CostTotal FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????Contractor Disposal and Recycle Costs Subtotal$ FORMTEXT ?????9(c). Contractor Labor CostsEmployeeActual Hours WorkedHourly WageTotal FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Contractor Labor Costs Subtotal$ FORMTEXT ?????9(d). Contractor Miscellaneous Supplies CostsSpecific ItemQuantityPer Unit CostTotal FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????Contractor Miscellaneous Supplies Costs Subtotal$ FORMTEXT ?????9(e). Total Contractor Cleanup Costs. Total the subtotal costs from Sections 9(a), 9(b), 9(c), and 9(d) of this form. Enter this amount in Section 7(b) of this form.$ FORMTEXT ?????10. COUNTY EMPLOYEE LABOR TIMESHEET10(a). Employee Name FORMTEXT ?????10(b). Position/Title FORMTEXT ?????10.(c) Dumpsite Name FORMTEXT ?????10(d). County Employee Work ScheduleDateStart TimeEnd TimeTotal Hours FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????10(e). Total Hours FORMTEXT ?????10(f). Hourly Wage$ FORMTEXT ?????10(g). Total Amount Paid$ FORMTEXT ?????10(h). Employee Signature FORMTEXT ????? Date: FORMTEXT ???/ FORMTEXT ???/ FORMTEXT ???10(i). Complete a form with the total number of volunteers/inmates (without names) that worked on the dumpsite. Add the total number of volunteers/inmates working, total hours worked, amount allowed and total amount.GENERAL INSTRUCTIONSIllegal Open Dump Cleanup Grant Program Final Expense WorksheetInstructions provided are for DEP 6088, Illegal Open Dump Cleanup Grant Program Final Expense Worksheet. For any questions regarding any category, please call the Division of Waste Management’s Recycling and Local Assistance Branch at (502) 564-6716. This form must be completed by typing or printing legibly.Important Note: This form is to be completed by city and local governments that receive anti-litter control grant funding in accordance with KRS 224.43-505 (2)(d).DEADLINE: Received by March 31st. Thirty (30) days after the end of each grant period.Submit DEP 6088 form to: Kentucky Department for Environmental ProtectionDivision of Waste ManagementRecycling and Local Assistance Branch300 Sower Boulevard, Second Floor Frankfort, KY 40601(502) 564-6716Section 1. Grant Year: Enter the calendar year being reported.Section 2. County: Enter the county where the illegal open dump is located.Section 3. Date(s) Cleaned: Enter date(s) when dumpsite cleanup occurred.Section 4. Dumpsite Name: Enter the full dumpsite name.Section 5. Agency Interest Number (Tempo ID): Enter the agency interest identification.Section 6. County Cleanup Costs: (a). County Equipment Costs: For each equipment cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each piece of equipment. Subtotal the amount of all equipment costs and enter.(b). County Disposal and Recycling Costs: For each disposal/recycling cost enter the information used for the cleanup project, including the “facility name and location”, “tons disposed or recycled”, “per ton cost”, and “total”. Multiply the “tons disposed or recycled” by the “per ton cost” and enter in the “total” column for each disposal/recycle cost. Subtotal the amount of all disposal/recycle costs and enter. Submit all disposal/recycling receipts with the “Illegal Open Dump Cleanup Grant Program Final Expense Worksheet.”(c). County Labor Costs: For each labor cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each labor cost. Subtotal the amount of all labor costs and enter.(d). County Miscellaneous Supplies Costs: For each miscellaneous supply cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each miscellaneous supply cost. Subtotal the amount of all miscellaneous supply costs and enter.(e). Total County Cleanup Costs: Combine subtotal amounts of county cleanup costs from Sections 6(a), 6(b), 6(c), and 6(d) and enter their total amount.Section 7. Project Summary Costs: Enter information for each category:(a). Total County Cleanup Costs: Enter amount from Section 6(e) of this form.(b). Total Contractor Cleanup Costs: Enter amount from contractor cleanup costs, Section 9(e).(c). Grand Total Cleanup Costs: Combine total amounts from Sections 7(a) and 7(b) and enter the project grand total amount costs.Section 8. Report Preparation: Enter the name of individual who prepares this report; date signed, mailing address, email address, phone and fax numbers.(General Instructions for DEP 6088 continued)Section 9. Contractor Cleanup Costs: If a contractor was used to work on the project enter information for each category:(a). Contractor Equipment Costs: For each equipment cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each piece of equipment. Subtotal the amount of all equipment costs and enter.(b). Contractor Disposal and Recycling Costs: For each disposal/recycling cost enter the information used for the cleanup project, including the “facility name and location”, “tons disposed or recycled”, “per ton cost”, and “total”. Multiply the “tons disposed or recycled” by the “per ton cost” and enter in the “total” column for each disposal/recycle cost. Subtotal the amount of all disposal/recycle costs and enter.(c). Contractor Labor Costs: For each labor cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each labor cost. Subtotal the amount of all labor costs and enter.(d). Contractor Miscellaneous Supplies Costs: For each miscellaneous supply cost enter the information used for the cleanup project, including the “funding source”, “actual hourly rate”, and “hours used”. Multiply the “actual hourly rate” by the “hours used” and enter in the “total” column for each miscellaneous supply cost. Subtotal the amount of all miscellaneous supply costs and enter.(e). Total Contractor Cleanup Costs: Combine subtotal amounts of contractor cleanup costs from Sections 9 (a), 9(b), 9(c), and 9(d) and enter their total amount.Section 10. County Employee Labor Timesheet(s): Complete one of these forms for each employee that was paid by grant fund dollars for this project. Include and attach all completed employee labor timesheets.(a). Employee Name: Enter employee’s full name.(b). Position/Title: Enter the position and/or title of the employee.(c) Dumpsite Name: Enter the name of the dumpsite.(d). County Employee’s Schedule: Enter each date with start and end times that the employee worked on this project. Enter the “total hours” for each day worked based on “start time” and “end time” for the employee.(e). Total Hours: Total the hours for every day employee worked in "total hours" column and enter amount.(f). Hourly Wage: Enter the amount of employee’s hourly wage.(g). Total Amount Paid: Multiply the total hours worked in Section 10(e) by the hourly wage in Section 10(f) and enter the amount in Section 10(g). For example,if an employee worked a total of five hours over the course of three days on this project with an hourly wage of $8.00, the employee’s total amount paid would be calculated as follows: 5 hours x $8.00= $40.00 Total Amount Paid.(h). Employee(s) must sign and date their County Employee Labor Timesheet to verify the hours worked on this project.(i). A form is to be completed with the total number of volunteers/inmates working on the dumpsite without names. Enter the total number of individuals who (volunteers/inmates) worked, total number of hours worked, amount allowed (minimum wage) and the overall total amount (i.e. hourly wage x number of hours x number of volunteers/inmates).All information submitted on this form will be subject to public disclosure to the extent provided by Kentucky law. Persons filing this form may make claims of confidentiality in accordance with 400 KAR 1:060. ................
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