Monroe County Municipal Waste Hauler Permit Application CALENDAR YEAR 2019

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1 Monroe County Municipal Waste Management Authority 183 Commercial Blvd., Blakeslee, PA Telephone: (570) Fax: (570) Monroe County Municipal Waste Hauler Permit Application CALENDAR YEAR 2019 The Monroe County Municipal Waste Management Authority (the Waste Authority) is the Implementing and enforcement agency of the Monroe County Municipal Waste Management Plan (the Plan), the Monroe County Municipal Waste Management Ordinance (the Ordinance) and the Monroe County Municipal Waste Management Rules and Regulations (the Rules and Regulations). All regulated waste haulers are required to register and obtain a permit from the Waste Authority for the collection, storage, transportation and disposal of regulated waste to a county designated facility. The permit shall be affixed onto your vehicle as to identify you as a registered waste hauler to access entry at a designated facility. All transporters of regulated waste must be in compliance and remain in compliance with the requirements of Act 97, Act 101, the Plan, the County Ordinance and the Waste Authority Rules and Regulations. These laws are enforced to ensure, maintain and protect the health and safety of the general public and the environment. Application Date: New Application Renewal DEP Number (if applicable) Expiration Date: Company Name: Mailing Address: Business Address: Operation Manager: Telephone ( (Name) ) Cell Phone ( ) Fax ( ) Address Employer ID Number (EIN) Type: Sole Proprietorship Partnership Corporation Association Municipality Page 1 of 8

2 Date of Birth (If applicant is an Individual or Sole Proprietorship) (mm/dd/year) APPLICANT OWNERSHIP INFORMATION If the Applicant is a partnership or corporate entity, list all individuals and/or parent corporate entities. (Please lists additional individuals on a separate sheet if necessary) 1. Name: DOB: (mm/dd/year) Address: Percentage:. 2. Name: DOB: (mm/dd/year) Address: Percentage:. INSURANCE INFORMATION: All persons applying, maintaining or renewing a permit to collect and transport Regulated Waste in Monroe County must obtain and maintain the following insurance coverage. Certificate(s) of Insurance are required for the insurances below. The Waste Authority must be listed as the Certificate Holder (A) Commercial Automobile Liability Insurance as required by The DEP and Pennsylvania State law and/or regulations; (B) Commercial Liability Insurance with a minimum coverage of $100, (C) Workers Compensation Insurance as required by Pennsylvania State law and/or regulations. If you do not have employees and do not have workers compensation insurance, you must check this box (D) Motor Vehicle Registration- Provide a copy of each registration if vehicle with a gross vehicle weight of 17,000 or less and waste trailer with a gross vehicle weight of 10,000 or less. Applicants who have an active DEP Act 90 Authorization do not have to provide motor vehicle registration copies. Those applicants will obtain a courtesy permit. Commonwealth of Pennsylvania Code Title 25. Department of Environmental Protection Compliance with the County Plan Designated Disposal Facility Requirements: Municipal waste disposal facilities and transporters are required to comply with county plans that specify which facilities are approved to receive waste from that county and Basic Limitations (i) A person or municipality may not allow solid waste to be received, disposed or otherwise managed at the facility if the transportation to, or processing or management at, the facility would violate applicable laws in Page 2 of 8

3 effect in the county or state in which the waste was generated, or state or local solid waste management plans in effect where the waste was generated Transportation to Permitted Facilities (a) Municipal waste shall be transported to prevent a nuisance or hazard to public health, safety or welfare. (b) No person or municipality may transport municipal waste to a solid waste processing or disposal facility in this Commonwealth, unless the facility has a permit from the Department that expressly allows processing or disposal of the type of municipal waste being transported. (c) No person or municipality may transport municipal waste in a manner contrary to the terms and conditions of a permit, an order issued by the Department or requirements in the act, the environmental protection acts or this title. Disposal Information: All solid waste collected and transported within the geographical boundaries of Monroe County must be processed and disposed of at a DEP approved designated disposal facility within the Monroe County Waste Management Plan and permitted by PA DEP. It is the Hauler s responsibility to accurately report the source generation as MONROE COUNTY when loads are taken to the landfill as set forth in the Ordinance and the Authority Rules and Regulations. Refer to website to download a copy of the Monroe County Ordinance and the Authority Rules and Regulations. Effective January 1, 2015, all loads must be processed and disposed of at the designated disposal facilities. The disposal rate per ton is inclusive of all Pennsylvania Environmental taxes, host community benefit fees and Integrated Waste Management system fees and taxes. The Disposal rates may be subject to change. The only two (2) approved designated disposal facilities under the Monroe County Waste Management Plan are as follows: 1. Alliance Landfill 2. Grand Central Sanitary Landfill (GCS) 398 S. Keyser Avenue 1963 Pen Argyl Road Taylor, PA Pen Argyl, PA (570) or (570) (610) or (610) Rate per Ton: $ Rate per Ton: $ Please contact Mr. Don Lucy at to arrange credit terms. Directions to Alliance Landfill: From Interstate 81 Use exit 182, follow signs for Taylor. Take Davis Street and then Union Street west across the Lackawanna River and through Taylor. Turn Left at the traffic light on Keyser Avenue and make the first right into Alliance Landfill. Tractor Trailers must use PA Turnpike; from I-476, the Northeast Extension of the Pennsylvania Turnpike, Use exit 38. Alliance Landfill is next to the Turnpike overpass at Keyser Avenue Directions to GCS Landfill- Route 33 to the Wind Gap 512 exit. Left onto 512 S Go to the 4th Traffic Light make right (Gas Station) continue approximately 1 mile pass the traffic light and Grand Central Sanitary Landfill will be approximately ¾ miles on the right. Please check all that apply: Municipal Solid Waste Municipal Sludge Self Haul (personal waste being hauled) Weekly curbside collection Construction/Demolition Roll-Off Clean Outs Page 3 of 8

4 Fee Schedule: Vehicle Weight Class Requirements Waste Authority Fee Registration Type Vehicles/Tractors 17,001 and over DEP License Courtesy Annual/ Per Vehicle Waste Trailers 10,001and over DEP License Courtesy Annual/ Per Trailer Vehicles 17,000 and under Waste Trailers 10,000 and under DEP License not required $25.00 Annual per vehicle Annual per trailer 10 Cubic Yards and above Per Container /Compactor $10.00 Annual - expires 12/31/2019 Permit replacement Fee Return old permit Free Per vehicle, trailer or container Permit replacement Fee Lost, stolen or mutilated $10.00 Per vehicle, trailer or container In addition to all other provisions/terms/language of this application, notice is hereby given to the Applicant concerning the following: Note 1: Permits are NOT transferrable and must remain with each vehicle, waste trailer, compactor and roll off. They must not be magnetized. If a registered vehicle, waste trailer, compactor or roll-off container is sold or in any way transferred, notice must be provided to the Waste Authority within five (5) days of such sale or transfer. All permits must be removed prior to the sale or transfer are to be returned to the Waste Authority. Roll-off containers/compactors used for recycling are not required to display permits. Permits must remain with each vehicle(s), Waste trailer(s) roll-off container(s) Compactor. Note 2: To add vehicles or purchase additional permit(s) please fill out Page 6 of this application and contact our office for further instructions. Note 3: Any registration and/or permit issued by the Waste Authority are subject to immediate revocation by the Waste Authority for any violation of the terms of this application. Note 4: If this application is approved, Applicant agrees to provide a full and complete list of all its customers within the geographic boundaries of Monroe County, Pennsylvania upon issuance of such a request by the Waste Authority. Applicant agrees to provide a full and complete response to a request for a customer list from the Waste Authority within five (5) days from the date the request is issued by the Waste Authority. Page 4 of 8

5 Method of Payment- (When using a credit card a $5.00 processing fee may be applied) Major Credit Cards Accepted Credit Card Type: Visa Master Card Discover American Express Credit Card # Expiration Date: CVP Code (3 digits back of card) Name as it appears on Card: Billing Address (Same address as credit card billing account) Street, City, State, Zip Code Business phone number Address: Page 5 of 8

6 FLEET INFORMATION (List all trucks, tractors and waste trailers) Permits expire 12/31/2019 Company Name PA DEP # Exp.Date: Company Description License MCMWMA Truck Gross Plate Vehicle Identification Number Permit Number Year Make Model Color Body Type Weight Number (VIN) (office Only) Compactors and roll-offs 10 cubic yards and above must display an annual non-transferrable access permit issued by the Waste Authority at all times Number of Roll-off containers to be (per permit)= $ When purchasing additional permits, you must fill out the section above with your company name- Signature Date: Page 6 of 8

7 CERTIFICATION I hereby certify that all the information provided in this application to be true and correct to the best of my knowledge, information, and belief. I also certify that all vehicles and containers specified herein are owned or leased by the applicant; that said information is true and correct; and that I am familiar with and will comply with the Ordinance and the Rules and Regulations. I/we agree to dispose of all regulated waste collected in Monroe County, Pennsylvania at a designated facility identified in the plan, which currently are Alliance Landfill and Grand Central Sanitary Landfill. I/we will pay all fees and accept all penalties set forth in the Plan, Act 97, Act 101, the Ordinance, the Rules and Regulations of Monroe County and the Waste Authority along with any other applicable statutes, regulations, ordinances or contractual agreements. Further, by executing this application, the Applicant hereby acknowledges and agrees to the jurisdiction and venue of the Court of Common Pleas of Monroe County Pennsylvania for any and all claims arising out of or in any way related to this application, its conditions or any subsequent registration or permitting by the Waste Authority. This certification must be notarized below and attached to the Waste Hauler application COMMONWEALTH OF PENNSYLVANIA, COUNTY OF I,, being duly sworn, according to law, (Applicant, please print) Upon my oath, do depose and say that I am the (Title) Of (Business Name) (Owner Signature or authorized officer with signatory responsibilities) Sworn to and subscribed before me this day of, (Notary Signature) Page 7 of 8

8 MAKE SURE YOU HAVE ENCLOSED THE FOLLOWING BEFORE MAILING: Allow 30 days for processing. In order for any application to be processed, it must be completed, notarized and accompanied by all necessary documents. Permits will Not be issued if application is incomplete and information is missing. Permit Application and Notary Page -Page 7 Completed and Signed before a notary public. Vehicle Identification log (page 6) separately list each vehicle, truck and trailer. Also list the total number of permits you will purchase for roll off containers and compactors. Vehicle registration If the gross vehicle weight is 17,000 or less and trailers with a gross vehicle weight of 10,000 or less. Certificates of Insurance All certificates of Insurance must name Monroe County Municipal Waste Management Authority as Certificate Holder (do not send copy of Insurance card) Notarized Certification- Make sure you have completed page 7 and have signed before A Notary public Check or money order payable to: Monroe County Municipal Waste Management Authority (MCMWMA) Payments may also be processed through our website using PayPal. When using this method of payment, please call our office. Credit Card Information (page 5) - If your payment method is by credit card, make sure you provide all of the necessary information for processing. Deliver or Mail To: Monroe County Municipal Waste Management Authority 183Commercial Blvd., Blakeslee, PA Page 8 of 8

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