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Home My WebLink AboutPart 360 Registrations for MSW & C&D Transfer 1997#" NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION BwMing 40 - SUNY, Stony Brook, New York 11790-2356 _ Phone (516) 444-0375ftme Fax (516) 4440231 - John A Cahill Acdng Con nhslowr Jim Bunchuk Solid Waste Coordinator -Town of Southold PO Box 962 Cutchogue, New York 11935. Dear Mr.Bunchuk: Enclosed is a validated copy of your registration form submitted to the New York State Department of Environmental Conservation pursuant to 6 NYCRR Part 360, to register the existing municipal solid waste transfer operation. This letter only acknowledges receipt of your registration form and does not, in any way, verifies that the information provided on the form is true or correct. In addition, you are responsible for obtaining any other permits and approvals that may be required; and for complying with all other applicable State and Federal laws, rules, regulations and all other applicable local ordinances including, but not limited to, zoning ordinances, building codes, Fire Marshal codes, etc. This registered activity shall in no way conflict with any mined land reclamation permit and approved reclamation plan. You are reminded that 6 NYCRR Part 360 contains various requirements that must be followed to warrant your facility's continued status as a registered facility. This information was provided in the registration package. If you have any questions regarding this matter or need an additional copy of the registration requirements, please contact me at the above telephone number. Sincerely, nthon ava, P.E. Regions Solid and Hazardous Materials Engineer AJC:ek enc. !.47-14-020 (01/94) . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF SOLID WASTE REGISTRATION FORM .FOR A SOLID WASTE MANAGEMENT FACILITY .,,Blease read and follow all instructions before completing this registration form - Pl T P i t le l TNIS IS NOT A "DA PERMIT ease ype or r n c ar y DEPARTMENT USE ONLY DEC REGISTRATION # 3 6''77 treat cosue t road 48 9 1 - DEC ADMI11ISTRAT10i # ✓ DATE RECEIVED % / 3! // 1q. 1. FACILITY NAME AND LOCATION 2. FACILITY OWNER'S NAME wouthold Town Transfer StationTown Of Southold treat cosue t road 48 Mailing Address City/Village City/Town/Village ,�'Ijtctiocfue Southold To1{n County SvuL'l1C1C Su C: State/Zip Code j1jeW YO]"1i 19171 Telephone Number Telephone Number ( ) ( ) 265-1,800 3. FACILITY OPERATOR'S NAME (if different) > 4. SITE OWNER'S NAME (if different) Saxe Same Mailing Address Mailing Address City/Town/Village City/Town/Village State/Zip Code State/Zip Code Telephone Number Telephone Number 5. TYPE OF FACILITY REGISTRATION (check all applicable boxes) Energy Recovery Incinerators or Pyrolysis Units O Source Separated, Nonputrescible Solid Waste Recyclables [360-3.1(c)] Handling and Recovery Facilities [360-12.1(d)] Land Application and Sludge Storage Facilities [360-4.1(c)] ElWaste Tire Retreaders [360-13.10)(1)(0] ElComposting and Other Distribution and Marketing Facilities ❑ Waste Tires Stored for On-site Energy Recovery [360-5.3(b)] [360-13.1(d)(1)(ii)] Land Clearing Debris Landfills three acres or less ❑ Tire Dealers Selling Waste Tires [360-13.1(d)Tl` y{"iii)] [360-7.2(a)] Tire Manufacturing Facilities [360-13.1(d)(1)(iv)] Transfer Stations (municipally owned/operated/contracted) receiving less than 50,000 cubic yards or 12,500 tons of Processing Facilities Receiving Only Recognizable household solid waste annually [360-11.1(b)(1)] Uncontaminated Concrete, Asphalt Pavement, Brick, Soil or Rock [360-16.1(d)(1)(i)] ❑ Transfer Stations (municipally owned/operated/contracted) receiving less than 50,000 cubic yards or 12,500 tons of ❑ Uncontaminated Unadulterated Wood Processing Facilities containerized solid waste annually [360-11.1(b)(2)] [360-16.1(d)(1)(ii)] D Other Facilities n2l_!pecificaLty described above, Specify Type 6. SOLID WASTE HANDLED 7. OPERATIONS SCHEDULE - Normal schedule of operation a. List wastes and/or materials to be accepted Mixed 7:00 am — 5:00 pm, 7 days per Municipal Solid Waste . week 8. NAME(S) OF ALL MUNICIPALITIES SERVED b. Quantity (Specify U its gee�A nstructions) design capacity �� SOU ions 7'C>1Tr1 of Southold Village of 8reenport storage on site 0 9. CERTIFICATION: an I here affirm under by penalty of perjury that information provided on this form and attached statements and exhibits was prepared by me or under my sypervision and direction and is true to the best of my knowledge and belief, and that I have Superyisur the authority as (title) of Town cf Southold (Entity) to sign this registration form pursuant to 6 NYCRR Part 360. By signing this registration form, I affirm that I have read the applicable regulations and will abide by all conditions of the registration requirements. I am aware that any false statement made herein is punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Printed/Typed Name Signature Mo. Day Year Jean W. Cochran q ;7 6 REGISTRANT'S VAL `DATED VOPY _,Copy #3 K„ (Th Rn Rats irnari by Isar._ i - c 47-14-020 (01/44) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF SOLID WASTE ° REGISTRATION FORM FOR A SOLID WASTE MANAGEMENT FACILITY T ,lease read and follow all instructions before completing this registration form Pl T P t l l THIS IS NOT A UPA PERMIT ease ype or rin c ear y DEPARTMENT USE ONLY DEC REGISTRATION #9 FC MI ty Road 48 Mailing AddressRUIOR Ma in 'Rnad' a DEC ADMINISTRATION *_ =DATE RECEIVED _Z / S/ / N FACILITY NAME AND LOCATION 2.` FACILITY OWNERiS NAME FC MI ty Road 48 Mailing AddressRUIOR Ma in 'Rnad' City/Village City/Town/Village Southold SouoThold C01"ty Suf folk stator code Nev.York 11 Telephone' Number Telephone Number ( '1 ( ) 265-1800 3. FACILITY OPERATOR'S NA14E (if different) "" # 4. SITE OWNER'S NAME (if different) Same - Same Mailing Address Mailing Address City/Town/Village City/Town/Village State/Zip Code State/Zip Codec# Telephone Number Telephone Number ( ) ( ) 5. TYPE OF FACILITY REGISTRATION (check all applicable boxes) OEnergy Recovery Incinerators or Pyrolysis Units Source Separated, Nonputrescible Solid Waste Recyclabtes [360-3.1(6)] Handling and Recovery Facilities [360-12.1(d)] OLand Application and Sludge Storage Facilities [360-4.1Cc)] Waste Tire Retreaders [360-13.1(d)( X03 Composting and Other Distribution and Marketing Facilities Waste Tires Stored for On-site Energy Recovery [360-5.30)] [360-13.1(d)(1)(i 03 Land Clearing Debris Landfills three acres or less 13Tire Dealers Selling Waste Tires [360-13.YCdyt-,,` iii )]=. [360-7.2(a)] Tire Manufacturing Facilities [360-13.1(d)(1)003 ' 'Transfer Stations (municipally owned/operated/contracted) . OProcessing receiving less then 50,000 cubic yards or 12,500 tons of Facilities Receiving Only Recognizable household solid waste annually [360-11.1(b)(1)] Uncontaminated Concrete, Asphalt Pavement, Brick, Soil, - L or Rock [360-16.1(d)(1)(03ETransfer Stations (municipally owned/operated/contracted) receiving less than 50,000 cubic yards or 12,500 tons of OUncontaminated Unadulterated Wood Processing Facilities containerized solid waste annually [360-11.1(b)(2)) E360-16.10)(1)003 Other Facilities not specifically described above ify;T 6. SOLID WASTE HANDLED 7. OPERATIONS SCHEDULE - Normal schedute of operation. a. List wastes and/or materials to be accepted Mixed 74.00 SID - 5 i 00 pa, 7 dayn per nd/ Municipal Solid Waste w_eek F 8. NAMES) OF ALL MUNICIPALITIES SERVED b. Quantity (Specifyit instructions) �0 Tow)2 of Southold design capacity .r ons storage on site 0 Village of fr"uport 9. CERTIFICATION: I hereby affirm under'penalty of perjdry that irtformation pron this form an& attached statements and exhibits was prepared by me or�r,der my, supervision and direction and -is t to the best of my knowledge and belief, and that I have the authority as Sup ' ervisor (titte) of Toith of,, SauLhdld (Entity) to sign this registration form pursuant to 6 NYCRR Part 360. 1W signing thif registration form, I.a ffrm that i have read the applicable regulations and wilt abide by alt'condi.ions of the registration re*irementt. I am aware that any false statement made 'herein '-is punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal taw. Printed/Typed Name St tur No. Day Year Jean W. Cochran '* . , F �, 9 ; �� 3 ; g -7 REGISTRAlALIDATED OP' OPY _ Returned by Dec.) `_47 -14 -Ci O (01/94) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF SOLID WASTE REGISTRATION FORM FOR A SOLID WASTE MANAGEMENT FACILITY Please read and follow all instructions before completing this registration form Please Type or Print clearly THIS IS NOT A UPA PERMIT DEPARTMENT USE ONLY DEC REGISTRATION# 16' Q Street Mailing Address C=► DEC ADMINISTRATION # �33V�'—" DATE —/� 20 1. FACILITY NAME AND LOCATION 2. FACILITY OWNER'S NAME Southold Town Transfer Station Town of Southold Street Mailing Address CountyRoad 4$ 5309S Main Road �� C6Lreci Ll8ggue y A g�3tu�TnoiVdl lage Town County Southold Sur; oli> State/Zip Code New Yor:s 11971 Telephone Number ( 516 ) 734-7885 Telephone Number - - ( ) 3. FACILITY OPERATOR'S NAME (if different) 4. SITE OWNER'S NAME (if different) Same Same Mailing Address Mailing Address City/Town/Village City/Town/Village State/Zip Code State/Zip Code Telephone Number Telephone Number 5. TYPE OF FACILITY REGISTRATION (check all applicable boxes) Energy Recovery Incinerators or Pyrolysis Units O Source Separated, Nonputrescible Solid Waste Recyclables [360-3.1(c)] Handling and Recovery Facilities [360-12.1(d)] Land Application and Sludge Storage Facilities [360-4.1(c)] E]Waste Tire Retreaders [360-13.1(d)(1)( 01 ElComposting and Other Distribution and Marketing Facilities ❑ Waste Tires Stored for On-site Energy Recovery [360-5.3(b)] [360-13.1(d)(1)( H)] Land Clearing Debris Landfills three acres or less E]Tire Dealers Selling Waste Tires [360-13.1(d)(1)(iii)] [360-7.2(a)] Tire Manufacturing Facilities [360-13.1(d)(1)(iv)] Transfer Stations (.municipally owned/operated/contracted) receiving less than 50,000 cubic yards or 12,500 tons of O Processing Facilities Receiving Only Recognizable household solid waste annually [360-11.1(b)(1)] Uncontaminated Concrete, Asphalt Pavement, Brick, Soil Transfer Stations (municipally owned/operated/contracted) or Rock [360-16.10)(1)(03 receiving less than 50,000 cubic yards or 12,500 tons of ElUncontaminated Unadulterated Wood Processing Facilities containerized solid waste annually [360-11.1(b)(2)3 [360-16.1(d)(1)(ii)i Transfer Station 6or Uncontaminated Other Facilities not specifically described above, Specify TypeCo n r, 6. SOLID WASTE HANDLED 7. OPERATIONS SCHEDULE - Normal schedule of operation a. List wastes and/or materials to be accepted 7: 00 am — : 00 pm, 7d8liti:S per \ c)c 'Istruci: i0ll & J1;'.AM.'..I.- i.tlon Debiis 8. NAME(S) OF ALL MUNICIPALITIES SERVED b. Quantity(Specify Wn (S cif it�s ,ase instructions) Qk, ions design capacity , . Town of Southold storage on site Q Village of ureenpork 9. CERTIFICATION: 1 hereby affirm under penalty of perjury that information provided on this form and attached statements and exhibits was prepared by me or r rvision and direction and is rue -.to t st of, mmyy wledge and belief, and that I hav6 the authorityas "a"%p r '�sor Ttown, o� (title) of _GULt1G�� (Entity) to sign this registration form pursuant to 6 NYCRR Part 360. By signing this registration form, I affirm that I have read the applicable regulations and will abide by all conditions of the registration requirements. I am aware that any false statement made herein is punishable`as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Printed/Typed Name Si nature Mo. Day Year Jean W. Cochran ; r -, � , .. ,.� L7q,. REGiSTRANTSVALIDATED COPY!. CO3,PY #.3 (TiM4P7 RP.t11rnP.r1 by DP(,,t,1` ' `47:14.020 (01/94)` NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL - CONSERVATION DIVISION OF SOLID WASTE REGISTRATION FORM FOR A SOLID WASTE MANAGEMENT FACILITY Please read and follow all instructions before completing this registration.;form Please Type or Print clearly THIS IS NOT A UPA PERMIT DEPARTMENT USE ONLY DEC REGISTRATION R � Taira of Southold Street o 'Q DEC ADMINISTRATIdN R 1"Ve DATE -98001 L )1_2LI (LIZ 7 1. FACILITY NAME AND LOCATION 2. FACILITY OWNER'S NAM Southold Town Transfer Station Taira of Southold Street Mailing Address CountV RQad 48 53095 1iLVGA Ile y[f t fila r0%ttage Town County State/Zip Code Southold Suffolk Nev York 11971 Tetep"hone Number:` Telephone Number ( 16 ) 724-2685 ( ) 3. FACILITY OPERATOR'S NAME (if different) 4. SITE OWNER'S NAME (if different) Same Same Mailing Address Malting Address City/Town/Village City/Town/Village State/Zip Code State/Zip Code Telephone Number Telephone Number ( ) ( ). 5. TYPE OF FACILITY REGISTRATION (check all appt;icebte boxes) DEnergy Recovery ]ncinerators or Pyrolysis Units E]Source Separated, Nonputrescible Solid Waste RecyctablgF [360-3.1(e)] Handling and Recovery Facilities [360-12.1(4)] ElLand Application and Sludge Storage Facilities 0360-4.1(c)] Waste Tire Retreaders [360-13.1(d)(1)(01 DComposting-and other Distribution and Marketing Facilities OWaste Tires Stored for On-site Energy Recovery' [360-5.3(b)} [360-13.1(d)(1')(ii)] Land Clearing Debris Landfills three acres or less E]Tire Deaters Setting Waste Tires [W- 13. 1 (d) 1 »t)3 E360 -7.2(a)1 E]Tire Manufacturing.Facilities [360-13.1(d)(1)(iv)]}' ElTransfer Stations (municipalty owned/operated/contracted) receiving less than 50,000 cubic yards or 12,500 tons ofProcessing Facilities Receiving Only Recogr►izatle household solid waste annually [360-11.1(b)(1)] Uncontaminated Concrete, Asphalt Pavement, Brick, Soal or Rock E360-16.10)(1)(01 []Transfer Stations (municipally owned/opermted/contracted) receiving less than 50,000 cubic yards or 12,500 tons of ElUncontaminated Unadulterated Wood Processing Facilities containerized solid waste annually [360-11.1(b)(2)] 1360-16.1(d)(1)(ii)I Transfer station *or Uncontaminated 5aOther facilities not specifically descri above, ify Type 6. SOLID WASTE HANDLED 7. OPERATIONS SCHEDULE - Normal schedule of operation t, a. List wastes and/or materials to be accepted 'tom as -- 5a00 on, 7d>wiM peryeek' Construction & Demolition Debiis 8. NAME(S) OF ALL MUNICIPALITIES SERVED b. Quantity (Specify Wwi�6Q�pIIttructions) design r.6pacity , i. TOYA Of Southold `' V11laGge of Greenport storage on site 0. CERTIFICATION: I hereby 'off irm under penalty of perjury that information providedon this form and attached statements and exhibits we prepared by me or t i ion and direction and is t t mfr ledge and belief, and that I hat � '� South the authority as (title) of (Entity) to, sign this registration form pursuant to 6 NYCRR Part 360. By signing this_I,g stration form, I'affirm that I have read the applicable regulations and wilt abide by alt conditi of the rtg stration requirements. I am aware that any fatse statement'made_herein is punishable'ks a Class A miftmeanorto>. tion 210.45 of the Penal ,Law. PrintedlTypem,ilAma Si Lure No. Day Year Jean W. Cochran �..�•, 4'. ' � 3 ` ��. 7 " FfEOtST �fALIDATED CO `AeWmed by D 3';' JAMES BUNCHUCK SOLID WASTE COORDINATOR September 23, 1997 SOUTHOLD TOWN SOLID WASTE DISTRICT Tony Cava Division of Solid & Hazardous Materials New York State DEC Region I SUNY Bldg. 40 Stony Brook, NY 11790-2356 Dear Mr. Cava: P.O. Box 962 Cutchogue, New York 11935 Tel: (516) 734-7685 Fax: (516) 734-7976 Enclosed are two completed Registration Forms For Solid Waste Management Facilities. One of the forms is to register the Town of Southold's existing MSW transfer operation, and the other is to register the Town's C&D transfer operation. We look forward to your response to these applications. Sincerely �an>�s Bunchuck cc: Supervisor Cochran Town Board Members Town Attorney ,s7-14.020 (01/94) NEM YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 6IVISION OF SOLID WASTE •REOIStRATION FORM FOR A SOLID WASTE MANAGEMENT FACILITY Please reed and follow sit instructions before completing this registration forms Plea" typo or Print clearly THiS iS NOT A UPA PERMIT DEPARTMENT USE ONLY DEC REGISTRATION 0 Sogthm d Town Transfer Station Town of Southold trNt counts- 48 Malting Address Main Road 53095lit:�iT ! 111 DEC ADMINISTRATION M r- DATE RECEIVED 1. FACILITY NAME AND LOCATION 2. FACILITY OWNER'S NAME Sogthm d Town Transfer Station Town of Southold trNt counts- 48 Malting Address Main Road 53095lit:�iT ! 111 Otu fro1 lfAttage Toth County State/Zip Coode cld Suffolk New York 11971 t -, Telephone Number ="r ( ) 3. FACt 11Y OPMTOVS NAME (if different) 4. SITE OWNER'S NAME (if different) Same Same Nall nd Address Mailing Address If, WAY AVViltop City/Town/Vittage State/!1p CemRe State/Zip Code elephonr Nublier Telephone Number S. TTPII OF FACI4ITT REGISTRATION (check all applicable boxes) 0Energy Recovery Incinerators or Pyrolysis Units 11 Source Separated, Nonputrescibte Solid waste Recyclobles t360.3.1(s)j Handling and Recovery Facilities [360-12.1(d)] Oland Appllsatisn and Sludge Storage Facilities [360-4.1(c)] ElWaste Tire Retreaders [360-13.10)(1)(0) dCommmposting 6W Other Distribution and Marketing Facilities [:] Waste Tires Stored for On-site Energy Recovery 00-9.30M [360-13.1(d)(1)(i0] Mand Clestifmly Debris LwWfiile three acres or less Tire Dealers Setting Waste Tires [360-13.1(d)(1)(iii)] Tire Manufacturing Facilities [360-13.1(d)(1)(iv)) ofiv infer aUt10M (mtnicipally owned/operated/contracted) +eeeivin* I"# !haft 50,000 cubic yards or 12,500 tons of ElProcessing Facilities Receiving Only Recognizable iiau mbolid 6009 unite annuatty [360.11.1(b)(1)] Uncontaminated Concrete, Asphalt Pavement, Brick, $oil or Rock [360-16.10)(1)(0] P'VWsfer Stdtitlnl (msunieipally owned/operated/contracted) 1"s than 50,000 cubic yards or 12,500 tons of O Uncontaminated Unadulterated Wood Processing Facilities =rtN:eiyifi 111i1 ti6d valid taste annually (360-11.1(b)(2)] [360-16.1(d)(1)(ii)] Transfer Station for Uncontaminated i�60111:1 not s If leatty described above Specify T 6.1.SOLID WAVE-OWLED 7. OPERATIONS SCHEDULE - Normal schedule of operation a. List agotes and/or materials to be accepted 7:00 am - 5:00 pm, 7ddays Coniir,ttuction & Demolition Debtis per week 8. NAMES) OF ALL MUNICIPALITIES SERVED b. Uumintlty (Specify Mr VO0*189thructions) Town of Southold design sapaeity storage an atte 0 Village of Greenport 9. it T im[CAt (Nit / h6rdiy affIM under penalty of perjury that'information provided on this form and attached statements and exhibits was ion and direction and isA1Vr & Ige$tUV1% Wwledge and belief, and that I have p ad by to or t"m m Ono tm til as (title) of (Entity) to sign this rootStretieln f6M pursuant to 6 NYCIIR Part By signing this registration form, 1 affirm that I have read the 6pPt1ftM# 1,601ations and will abide by all conditions of the registration requirements. I sm aware that any false. itatimrlwitt i�iammM ,Fero is punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Low. Pr yped Nm Sl lure No. Day Yeor J41an 11: Cochran q % REGIONAL OFFICE COPY - COPY #1 4f-14-020 (01/44) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF SOLID WASTE REGISTRATION FORM FOR A SOLID WASTE MANAGEMENT FACILITY Piss" rood and follow sit instructions before compteting this nVistrotien form Plot$* Typo or Print elearly THIS IS NOT A UPA PERMIT DEPARTMENT USE ONLY DEC REGISTRATION 0 11old Town Transfer Station Town Of Southold .c2ou CA'N'y toad ` 48 Malting Address 53095 Main Road T] DEC ADMINISTRATION s DATE RECEIVED 1. FACILITY NAME AND LOCATION 2. FACILITY OWNER'S NAME 11old Town Transfer Station Town Of Southold .c2ou CA'N'y toad ` 48 Malting Address 53095 Main Road City/Vilts" Cit /1 dVintage Soutiol County SJUOThold Suffolk State/Zip Code New YorK 119911 T! Murber . Telephone Number ( 516 )7§5-109Q I 3. FACILITY 009RATOR+S NAME (if different) 4. SITE OWNER'S NAME (if different) Same Same Netting Address Mailing Address City/TasVVilloge City/town/Village state/tip Cade State/Zip Code T!tlphono r Telephone Number S. TYPE OF FAC U TY REGISTRATION (check all applicable boxes) 131h*rgy Reeutvery Incinerators or Pyrolysis Units []Source Separated, Nonputrescibte Solid Waste Recyclebtes t36tF-3.1(l:)l Handling and Recovery Facilities 1360-12.1(d)l OLlnd Application and sludge Storage Facilities 1360-4.1(c)) D Waste Tire Retreaders 1360-13.10)(1)(0) 0 Composting and Other Distribution and Marketing Facilities [:] Waste Tires Stored for on-site Energy Recovery (36D -5.30)I 1360-13.10)(1)001 ❑ { Closefr Olbrti Landfills three acres or less ElTire Dealers Selling Waste Tires 1360-13.1(d)(1)(iii)l tM4.200 Tire Manufacturing Facilities (360-13.1(d)(1)(iv)l t�1 9i thihifer ittstf&w (amfcipally owned/operated/contracted) rleefOng togs thin 50,000 cubic yards or 12,500 tons of Processing Facilities Receiving only Recognizable harlshotd solid mute annually 1360-11.1(b)(1)) Uncontaminated Concrete, Asphalt Pavement, Brick, Soil or Rock 1360-16.10)(1)(03[lie onoiw stations (amicipatly owned/operated/contracted) iriiw:wfVInS lase than $0,000 cubic yards or 12,500 tons of Uncontaminated Unadulterated.Wood Processing Facilities e0*4fftH*d t "lid waste annually 1360-11.1(b)(2)) 1360-16.1(d)(1)(ii)) �Dt1MMw,Faetu os not =21caLLz described above, SpecifyT & ;IIKID WWII.11AMLED 7. OPERATIONS SCHEDULE - Normat schedule of operation a. List wastes end/or materials to be accepted Mixed 7:00 am - 5:00 pm, 7 days per Municipal Solid Waste wee 8. NAME(S) OF ALL MUNICIPALITIES SERVED b. Quantity (Specify t�itt6deq,if_uctions) Town of Southold design Capacity storara an Ote, 0 Village of Greenport �.: CERTIFICA IfiNa I MrAby effiNM under penalty of perjury that information provided on this.form and attached statements and exhibits propored try No or rmy s rvision and direction and i true to a fest o} my ledge and belief, and that t h ay$Ysor (title) of own of Southold (Entity) to sign this roelatra'tfon #Oris pursuant to 6 NYCRR Part 360. By signing this registration form, I affirm that I have read the ]-7 appliw:abtwt rosulations and will gide by all conditions of the registration requirements. I am aware that any false stltamlwilwt`.illrkM herein is punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Print NaAI! Si ature No. Day Y Jean W Cochran O o2 3 9 V REGIONAL OFFICE COPY - COPY #1 i A r1\ *O ftk' u� t r1\ *O ftk'