VOLUME REDUCTION - CONSTRUCTION AND DEMOLITION …



Department of Energy & Environmental Protection

Bureau of Materials Management & Compliance Assurance

79 Elm Street - 4th Floor

Hartford, CT 06106-5127

Construction & Demolition (C&D) Waste Volume Reduction Plant (VRP) Quarterly Solid Waste (SW) Reporting Form For now, please use this draft version of the reporting form or a DEEP approved custom version of this reporting form 1/23/2018 ver

Name of Facility:      Permittee:      SW Permit #:     

Facility Location: Street:      Town:       State:      Zip Code:     

Mailing Address:      

Only those sections of the form relevant to the types of waste received at your facility need to be submitted as follows:

|Links to Different Sections of this Reporting Form |Waste Type is Received|Comments |

| |at this Facility | |

|C&D Waste and Oversized MSW Received | Yes |Waste and recyclables received from a building construction or demolition or |

| | |renovation site. Components include, but are not limited to, concrete, asphalt,|

|Facility needs to indicate if the quarter tonnage includes | |wood, brick, metals, structural plastic, wallboard, roofing shingles, etc. |

|disaster debris | | |

| | |Oversized MSW includes, but is not limited to, carpet, mattresses, furniture, |

| | |large plastic children’s toys, etc not generated at a construction or |

| | |demolition or structural renovation site |

| |

|Source Separated Recyclables Received | |Source separated recyclables – such as bottles, cans, paper, cartons, scrap |

| |Yes |metal, yard waste, waste oil, etc. |

| |

|MSW RECEIVED (not including loads of source separated recyclables)| Yes |Regular trash – not oversized |

| | | |

|Observations of Incoming Loads of CT Solid Waste (other than source separated recyclables)|All C&D VRPs |

|Containing >10% Designated Recyclables and Incoming Loads of CT Source Separated | |

|Designated Recyclables with >5% Contamination | |

| | |

| Certification |All C&D VRPs |

Typical Components of Building-Related C&D Debris : Wood - forming and framing lumber, stumps, plywood, laminates, scraps; Drywall- sheetrock, gypsum, plaster; Metals - pipes, rebar, flashing, steel, aluminium, copper, brass, stainless steel; Plastics - vinyl siding, doors, windows, floor tiles, pipes; Roofing - asphalt and wood shingles, slate, tile, roofing felt; Rubble - asphalt, concrete, cinder blocks, rock, earth; Brick - bricks, decorative blocks; Glass - windows, mirrors, lights; Misc. - carpeting, fixtures, insulation, ceramic tile.

Does Facility Have a Scale? YES NO

|If Facility Does Not Weigh Tonnage, Please Describe Method for Estimating Tonnage Reported:       |

REPORTING QUARTER: YEAR:       QUARTER: 1ST-Jan-Mar; 2nd Apr-Jun; 3rd Jul-Sep; 4th Oct-Dec

C&D BUILIDING WASTE/OVERSIZED MSW

Part A QUANTITIES BUILDING C&D WASTE/OVERSIZED MSW RECEIVED

| |

|BUILDING C&D WASTE/OVERESIZED MSW RECEIVED FROM A REGIONAL SOLID WASTE FACILITY |

|ORIGIN: Regional Solid Waste Facility from which BUILDING C&D Waste and/or |DESCRIPTION OF MATERIAL AS RECEIVED (PRIOR TO PROCESSING) |Tons Received this QUARTER |

|OVERSIZED MSW was Received – Name & Location | | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:      | |

|      |Select from Dropdown |      |

| |If other –specify:      | |

|      |Select from Dropdown |      |

| |If other –specify:      | |

|      |Select from Dropdown |      |

| |If other –specify:      | |

|ORIGIN |BUILDING C&D WASTE and OVERSIZED MSW RECEIVED FROM a CT MUNICIPAL TS or DIRECT HAUL from a CONNECTICUT CONSTRUCTION or DEMOLITION SITE (Not |

| |from a regional solid waste facility) Oversized MSW MUST be reported by town of origin |

|CONNECTICUT |DESCRIPTION OF MATERIAL (PRIOR TO PROCESSING) |For Oversized MSW – CT City or Town of Origin |Tons Received |

| | | |this Quarter |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|CONNECTICUT |Select from Dropdown | If Oversized MSW specify CT city or town of | |

| |If other –specify:       |origin: | |

| | |      | |

|C&D BUILIDNG WASTE and OVERSIZED MSW RECEIVED FROM OUT- OF- STATE CONSTRUCTION or DEMOLITION SITES (not from a regional solid waste facility) |

|STATE OF ORIGIN |DESCRIPTION OF MATERIAL |QUARTER TOTAL |

| |(PRIOR TO PROCESSING) | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

C&D WASTE OVERSIZED MSW

Part B - QUANTITIES C&D WASTE and OVERSIZED MSW SENT OUT

|MATERIAL RECOVERED from C&D WASTE and OVERSIZED MSW & SENT TO RECYLING, END-MARKES OR REUSE FACILITIES (Material BURNED for energy is considered DISPOSED |

| |RECYCLING DESTINATION NAME & LOCATION |Destination |Tons Recycled this |

|C&D MATERIAL and OVERSIZED MSW RECYCLED/ |(If Material Is Managed thru a Broker – Indicate Destination State or|Type |QUARTER |

|REUSED |Country) | | |

|CLEAN WOOD OR |      | |      |

|CLEAN WOOD CHIPS (300) | | | |

| |      | |      |

| |      | |      |

|TREATED WOOD (301) |      | |      |

| |      | |      |

| |      | |      |

|SCRAP METAL (220) |      | |      |

| |      | |      |

|CLEAN FILL (302) |      | |      |

| |      | |      |

| |      | |      |

|CORRUGATED |      | |      |

| |      | |      |

|GYPSUM DRY WALL (307) |      | |      |

| |      | |      |

|ASPHALT ROOF SHINGLES |      | |      |

|OTHER – Specify      |      | |      |

|OTHER – Specify      |      | |      |

|OTHER – Specify      |      | |      |

|OTHER – Specify      |      | |      |

|C&D WASTE and OVERSIZED MSW SENT TO DISPOSAL FACILITIES (or to TSs for TRANSER to DISPOSAL) (Material BURNED for energy or used as alternative daily LF cover is considered|

|DISPOSED) |

| | |Tons Disposed this |

|TYPE OF WASTE DISPOSED |DISPOSAL DESTINATION |QUARTER |

| |Name & Address of Disposal Destination |Choose type of disposal destination from |      |

| | |drop-down menu | |

|OVER-SIZED MSW (DISPOSED) Carpet, Mattresses, |      | |      |

|Furniture, etc. | | | |

|MIXED C&D WASTE (DISPOSED) |      | |      |

|C&D WASTE PROCESS RESIDUE |      | |      |

|TREATED WOOD (DISPOSED) |      | |      |

|UNTREATED WOOD (DISPOSED) |      | |      |

|OTHER WASTE - TYPE: |      | |      |

|      | | | |

| |      | |      |

|OTHER WASTE - TYPE: |      | |      |

|      | | | |

| |      | |      |

C&D WASTE/OVERSIZED MSW PartC – BALANCE SHEET: QUANTITIES C&D WASTE and OVERSIZED MSW RCVD VS SENT OUT

|COMPARE TOTAL RECEIVED VS TOTAL SENT OUT for THIS QUARTER - C&D Waste Processing |

|Total Amount Received:      Total Sent Out:      Difference (Recev’d Vs Sent Out:)      % Discrepancy:      |

|If discrepancy is >10% - Please explain:       |

|Does the C&D Waste/Oversized MSW tonnage for this quarter include disaster debris? Yes No If yes – percentage estimate:       |

SOURCE SEPARATED RECYCLABLES

Source Separated Recyclables Part A- QUANTITIES Source Separated RECYCLABLES RECEIVED

| |

|Source Separated MSW Recyclables RECEIVED FROM A CT REGIONAL SOLID WASTE (SW) FACILITY |

| | |Tons Received this Quarter |

|NAME/LOCATION OF REGIONAL SW FACILITY OF ORIGIN |TYPE OF RECYCLABLE | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

| |Select from Dropdown |      |

|      |If other –specify:       | |

|Source Separated MSW Recyclables RECEIVED DIRECT HAUL FROM CONNECTICUT GENERATORS or from CT MUNICIPAL TRANSFER STATIONS (But not from regional solid waste facilities) |

|ORIGIN | | |Tons Received this |

|For Bottles, Cans, Cartons, Paper (BCP) – Report CT CITY/TOWN|TYPE OF RECYCLABLE |SOURCE –Only for BCP |QUARTER |

|OF ORIGIN | | | |

|Otherwise just report as Connecticut | | | |

|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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|      |Select from Dropdown |[pic][pic][pic] |      |

| |If other –specify: | | |

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| |If other –specify: | | |

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|Source Separated MSW Recyclables RECEIVED FROM OUT- OF- STATE |

| | |Tons Received this Quarter |

|STATE OF ORGIN |TYPE OF RECYCLABLE | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

|      |Select from Dropdown |      |

| |If other –specify:       | |

Source Separated MSW Recyclables Part B- QUANTITIES SENT OUT from the SOURCE SEPARATED RECYCLING SECTION of the FACILITY

|Source Separated Recyclables SENT TO RECYLING OR REUSE FACILITIES OR END-MARKETS - Material BURNED for energy (except “Waste Oil”) is not recycled. |

| | |RECYCLING DESTINATION |Tons Recycled this QUARTER |

|MATERIAL RECYCLED |RECYCLING DESTINATIOI NAME/LOCATION |TYPE | |

| |(If Material Is Managed thru a Broker – Indicate Destination State or | | |

| |Country) | | |

| CORRUGATED |      | |      |

| |      | |      |

|NEWSPAPER |      | |      |

| |      | |      |

|OFFICE PAPER |      | |      |

| |      | |      |

|MIXED PAPER |      | |      |

|Includes:       | | | |

| |      | |      |

|SCRAP METAL from MSW |      | |      |

| |      | |      |

|COMMINGLED BOTTLES & CANS |      | |      |

|Includes:       | | | |

| |      | |      |

|ALUMINUM CANS |      | |      |

| |      | |      |

|ALUMINUM FOIL |      | |      |

|MIXED GLASS |      | |      |

|FLINT GLASS |      | |      |

| |      | |      |

|AMBER GLASS |      | |      |

| |      | |      |

|GREEN GLASS |      | |      |

|STEEL CANS |      | |      |

| |      | |      |

|MIXED PLASTIC |      | |      |

|Includes:       | | | |

|MIXED HDPE |      | |      |

|COLOR HDPE |      | |      |

|NATURAL HDPE |      | |      |

|MIXED PET |      | |      |

|COLOR PET |      | |      |

|CLEAR (NO COLOR) PET |      | |      |

|LDPE FILM |      | |      |

|POLYPROPYLENE |      | |      |

|ASEPTIC BOXES/CARTONS |      | |      |

|FINISHED COMPOST |      | |      |

|LEAVES |      | |      |

|WOOD MULCH |      | |      |

|WOOD CHIPS |      | |      |

|SCRAP METAL (from MSW including |      | |      |

|appliances) | | | |

| |      | |      |

|SINGLE STREAM MIX OF RECYCLABLES |      | |      |

| |      | |      |

|OTHER – Specify: |      | |      |

|      | | | |

| |      | |      |

|OTHER – Specify: |      | |      |

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|OTHER – Specify: |      | |      |

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|OTHER – Specify: |      | |      |

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|OTHER – Specify: |      | |      |

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|OTHER – Specify: |      | |      |

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| |      | |      |

|Residue Generated from the Processing of the Source Separated Recyclables and Disposed - Material BURNED for energy (except “Waste Oil”) should be reported as disposed. |

| | |DISPOSAL DESTINATION TYPE |Tons Disposed this |

|MATERIAL DISPOSED |DISPOSAL DESTINATION NAME/LOCATION | |QUARTER |

|MSW DISPOSED - Residue from |      | |      |

|processing SS MSW recyclables | |If Other Specify:       | |

| |      | |      |

| | |If Other Specify:       | |

| |      | |      |

| | |If Other Specify:       | |

Source Separated Recyclables Part C- BALANCE SHEET: QUANTITIES SOURCE SEPARATED RECYCLABLES RCVD vs SENT OUT (i.e. marketed and residue).

|COMPARE TOTAL RECEIVED VS TOTAL SENT OUT FROM Source Separated MSW RECYCLABLES |

|Total Amount Received:       Total Sent Out:      Difference (Recev’d Vs Sent Out):      % Discrepancy:      |

|If discrepancy is >10% - Explain:       |

|Optional: Percent of Source Separated Recyclables Received for Transfer Only from a Regional SW facility (i.e. already processed at the sending|QUARTER AVERAGE |

|facility and not processed at this facility) | |

| |     % |

MSW (other than source separated recyclables) (For those facilities permitted to receive MSW)

MSW Part A - MSW RECEIVED

|MSW RECEIVED FROM A REGIONAL SOLID WASTE FACILITY |

| |Tons Received this |

|NAME/LOCATION OF REGIONAL SOLID WASTE FACILITY OF ORIGIN |QUARTER |

|      |      |

|      |      |

|      |      |

|      |      |

|      |      |

| |MSW RECEIVED FROM CONNECTICUT DIRECT HAUL or FROM A MUNICIPAL TRANSFER STATION (But not from a regional solid waste facility) |

| |Estimate % from |Tons Received this |

|CONNECTICUT CITY/TOWN OF ORIGIN |Residential Sources |QUARTER |

|      |      |      |

|      |      |      |

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Residential sources include single family homes, condominiums, multi-family buildings.

|RECEIVED FROM OUT-OF-STATE |

| |Tons Received this Quarter|

|STATE OF ORIGIN (NOT CT) | |

|      |      |

|      |      |

|      |      |

MSW Part B - MSW TRANSFERRED OUT for DISPOSAL FROM THE MSW SECTION of the FACILITY

|DESTINATIONS & QUANTITIES OF MSW TRANSFERRED OUT to DISPOSAL |

| | |Tons Transferred Out this |

|MATERIAL TRANSFERRED OUT |DESTINATION NAME/LOCATION |Quarter |

|MSW to DISPOSAL |      |      |

| | | |

| | | |

| |      |      |

MSW Part C - RECYCLABLES RECOVERED FROM LOADS of MSW (Other than from Loads of Source Separated Recyclables) (The presence of designated recyclables in MSW received for transfer indicates a possible violation of Connecticut’s requirement for generators to separate designated recyclables from other solid waste pursuant to CGS 22a-241b as clarified by Section 3 of PA 10-87.)

|DESTINATIONS AND QUANTITIES OF RECYCLABLES RECOVERED from LOADS of MSW (Other than from Loads of Source Separated Recyclables) (Material BURNED for energy (except |

|“Waste Oil”) is considered disposed, not recycled. |

|MATERIAL RECYCLED from MSW RECEIVED FOR| |Tons Recovered from MSW (not from source |

|TRANSFER |RECYCLING DESTINATION – NAME/LOCATION |separated loads) |

|COMMINGLED CONTAINERS (Mixed bottles |      |      |

|and cans) | | |

| |      |      |

|CORRUGATED |      |      |

| |      |      |

|NEWSPAPER |      |      |

| |      |      |

|OFFICE PAPER |      |      |

| |      |      |

|MIXED PAPER |      |      |

|Includes:       | | |

| |      |      |

|SCRAP METAL |      |      |

| |      |      |

|ALUMINUM CANS |      |      |

| |      |      |

|FLINT GLASS |      |      |

| |      |      |

| |      |      |

|AMBER GLASS | | |

| |      |      |

| |      |      |

|STEEL CANS | | |

| |      |      |

|SCRAP METAL |      |      |

| |      |      |

|SINGLE STREAM MIX OF RECYCLABLES |      |      |

| |      |      |

|OTHER – Specify:       |      |      |

| |      |      |

|OTHER – Specify:       |      |      |

| |      |      |

MSW Transfer Part D- BALANCE SHEET: QUANTITIES of MSW RECEIVED vs TRANSFERRED OUT

|COMPARE TOTAL RECEIVED VS TOTAL SENT OUT from MSW TRANSFER Section of the facility |

|Total Amount Received:      Total Sent Out:      Difference (Rcv’d Vs Sent Out):      % Discrepancy:      |

|If discrepancy is >10% - Explain:       |

ROUTINE VISUAL OBSERVATIONS of INCOMING LOADS OF CT SOLID WASTE

PART A - ROUTINE VISUAL OBSERVATIONS – INCOMING LOADS of SOLID WASTE (other than source separated recyclables) OBSERVED TO CONTAIN GREATER THAN 10% (by volume of - DESIGNATED RECYCLABLES )

Pursuant to solid waste permit requirements and/or CGS Sec 22a220c(b)

|TYPE OF SOLID WASTE LOAD RECEIVED |For this Quarter: BASED on ROUTINE OBSERVATIONS of LOADS RECEIVED THIS QUARTER – WHAT WAS THE ESTIMATED PERCENT |

| |of INCOMING LOADS of SOLID WASTE (other than loads of source separated recyclables) |

| |CONTAINING >10% DESIGNATED RECYCLABLES |

|CT C&D Waste |      % |

|CT Oversized MSW |      % |

|CT MSW |      % |

|LIST of ENTITIES (Regional Solid Waste Facilities; Haulers/Collectors; Municipalities; etc.) Notified About Their CT Loads of Solid Waste (other than loads of source |

|separated recyclables) Observed to Contain >10% Designated Recyclables |

|Name and Address of Entity Notified |Contact Info (Phone #; e-mail address; etc.)|Entity Type |Number of Loads of Solid Waste (other than |

| | |(Hauler, Regional SW Facility; |loads of source separated recyclables) |

| | |Municipality; Other) |Observed to Contain >10% Designated |

| | | |Recyclables Delivered this Quarter |

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Attach Additional Sheets if Needed

PART B - ROUTINE VISUAL OBSERVATIONS- INCOMING LOADS of CT SOURCE SEPARATED DESIGNATED RECYCLABLES OBSERVED to CONTAIN GREATER THAN 5% NON-RECYCLABLE MATERIAL (e.g. out throws; material not appropriate for the type of materials specified as acceptable by the receiving facility; etc.) (Pursuant to solid waste permit requirements). Please note-your permit may designate a threshold of >2% contamination, but only report data for loads of source separated recyclables observed to contain >5% non- recyclable material

Percent of Incoming Loads of Source Separated Designated Recyclables Containing > 5% non-recyclable material

QUARTER/YEAR:      

|TYPE OF CONNECTICUT SOURCE-SEPARATED RECYCLABLES RECEIVED |For this Quarter: ESTIMATED PERCENT of INCOMING LOADS of SOURCE|Major Types of Non-Recyclable Material |

| |SEPARATED DESIGNATED RECYCLABLES which CONTAINED >5% INCOMING |Observed in Such Loads |

| |CONTAMINATION ( | |

|Source Separated Recyclables from a Construction site |      % of with >5% incoming non-recyclable material |      |

|Source Separated Recyclables from a Demolition Site |      % of with >5% incoming non-recyclable material |      |

|Source Separated Bottles, Cans, Paper Recyclables not from a |      % of with >5% incoming non-recyclable material |      |

|Construction or Demolition Site | | |

|Yard Waste – leaves, grass, brush |      % of with >5% incoming non-recyclable material |      |

|Source Separated Food Scraps |      % of with >5% incoming non-recyclable material |      |

|Other Types of Source Separated Recyclables -Specify type: |      % of with >5% incoming non-recyclable material |      |

|Other Types of Source Separated Recyclables -Specify type: |      % of with >5% incoming non-recyclable material |      |

|Other Types of Source Separated Recyclables -Specify type: |      % of with >5% incoming non-recyclable material |      |

Entities Notified of Incoming Loads of Source Separated Recyclables Containing >5% Non-Recyclable Material

QUARTER/YEAR:      

|LIST of ENTITIES (Regional Solid Waste Facilities; Haulers/Collectors; Municipalities; etc.) Notified About Their CT Loads of Source Separated Recyclables Containing >5% |

|Incoming Contamination |

|Name and Address of Entity Notified |Contact Info (Phone #; e-mail address, etc.) |Entity Type |Number of Contaminated Loads of|

| | |(Hauler, Regional SW Facility; |Source Separated Recyclables |

| | |Municipality; Other) |Delivered this Quarter |

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Attach Additional Sheets if Needed

CERTIFICATION and SIGNATURE

This document, which is required to be submitted to the Commissioner of Environmental Protection, shall be signed by the Permittee or, if Permittee is not an individual, by Permittee’s chief executive officer or a duly authorized representative of such officer, as those terms are defined in §22a-430-3(b)(2) of the Regulations of Connecticut State Agencies, and by the individual(s) responsible for actually preparing such document, and each such individual shall certify in writing as follows:

“I have personally examined and am familiar with the information submitted in this document and all attachments thereto, and I certify, based on reasonable investigation, including my inquiry of those individuals responsible for obtaining the information, that the submitted information is true, accurate and complete to the best of my knowledge and belief. I understand that any false statement made in the submitted information may be punishable as a criminal offense under §53a-157b of the Connecticut General Statutes and any other applicable law.”

Signature of permittee or duly authorized representative of permittee: _____________________________________ Date:      

Printed name:       Title:      

Signature of person responsible for preparing report: ______________________________________ Date:      

Printed name:       Title:      

Phone #:       Fax #:       E-mail Address:      

If you own or operate more than one C&D VRP a form shall be completed for each plant.

How should the form be submitted?

Completed forms can be submitted to the CT Department of Energy& Environmental Protection by any ONE of the following methods:

( Fax (860) 424-4059 Attn: Solid Waste Facility Reporting- Paula Guerrera; Or

( Scanned & E-Mailed To DEEP.Solid&HazWasteReports@ (Do not send hard copy if sending electronically); Or

( Land-Mailed (CT DEEP; Bureau of MM&CA; 79 Elm Street - 4th Floor; -Hartford, CT 06106-5127; Attn: Solid Waste Facility Reporting – Paula Guerrera)

Must be double-sided and preferably on paper with a minimum 30% post-consumer content.

PLEASE CONSERVE PAPER - Do not fax or submit pages or sections that you intentionally left blank.

Contact Paula Guerrera (860 424-3334) to confirm receipt of report by DEEP

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