NWW Report Form



NATURAL WOOD WASTE RECYCLING FACILITY (NWWRF)Annual Tonnage ReportCalendar Year ________ _Permittee: ____________________________ NWWRF Permit No: __________________NWWRF Name: _____________________________________________________________NWWRF Address: ___________________________________________________________City: _____________________ County: __________________ Zip Code: ____________Certification: This is to certify that the information provided in this report and any attached document is true, accurate, and complete.Signature: __________________________ Name and Title: _________________________Telephone #: ________________ Fax: _____________ Email: ________________________________________________________________________________________The Annual Tonnage Report (Tables A & B) describes the activities of permitted Natural Wood Waste Recycling Facilities for the preceding calendar year commencing on January 1st and ending on December 31st. The signed Annual Tonnage Report is due on or by March 1st for the previous calendar year data and is to be submitted to MDE by using one of the following methods: ADVANCE \d 5 Mailing Address:Attn: Tariq Masood, Project ManagerMaryland Department of the EnvironmentLand and Materials AdministrationResource Management Program1800 Washington Boulevard, Suite 610Baltimore MD 21230-1719Telephone:(410) 537-3326Fax:(410) 537-3321Email:tariq.masood@All waste quantities are to be reported in units of tons and cubic yards rounded off to whole numbers. For facilities without scales, the conversion factor used to convert cubic yards to tons shall be included in the Report. If additional pages are required, identify all pages with facility name and Natural Wood Waste Recycling Facility Permit Number.Table A - Quantities of Natural Wood Waste Received104775014541500536892515557500Facility Name: NWWRF Permit No.: Calendar Year: ____Supplemental pages(s) attached? Yes NoNATURAL WOOD WASTE RECEIVED ADVANCE \d 3 MONTHSTATE ADVANCE \d 3 COUNTYVOLUME(Cu. Yd.)WEIGHT(Tons)TOTALTable B – Quantities of Natural Wood Waste Processed, Residual Produced, and Material Removed104775014541500536892515557500Facility Name: NWWRF Permit No.: Calendar Year: _____Supplemental pages(s) attached? Yes NoNATURAL WOOD WASTEPRODUCT PRODUCEDBY PROCESSINGNATURAL WOOD WASTEPRODUCT REMOVEDFROM THE FACILITYRESIDUAL WASTEREMOVED FROM THEFACILITYMONTHVOLUME(Cu. Yd.)WEIGHT(Tons)VOLUME(Cu. Yd.)WEIGHT(Tons)VOLUME(Cu. Yd.)WEIGHT(Tons)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTOTALTable A - Quantities of Natural Wood Waste Received (Supplemental page) 104775014541500536892515557500Facility Name: NWWRF Permit No.: Calendar Year: _____ Supplemental page _____ of _____NATURAL WOOD WASTE RECEIVED ADVANCE \d 3 MONTHSTATE ADVANCE \d 3 COUNTYVOLUME(Cu. Yd.)WEIGHT(Tons)TOTALTable B – Quantities of Natural Wood Waste Processed, Residual Produced, and Material Removed (Supplemental Page)104775014541500536892515557500Facility Name: NWWRF Permit No.: Calendar Year: _____ Supplemental page _____ of _____NATURAL WOOD WASTEPRODUCT PRODUCEDBY PROCESSINGNATURAL WOOD WASTEPRODUCT REMOVEDFROM THE FACILITYRESIDUAL WASTEREMOVED FROM THEFACILITYMONTHVOLUME(Cu. Yd.)WEIGHT(Tons)VOLUME(Cu. Yd.)WEIGHT(Tons)VOLUME(Cu. Yd.)WEIGHT(Tons)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberTOTAL ................
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