Chautauqua County, NY · Chautauqua County
Application for Treatment or Disposal of an Industrial Waste Stream
This application collects information about an industrial waste stream for a generator seeking treatment or disposal at a facility such as the Chautauqua County Landfill.
At a glance
- Issued by
- City of Chautauqua County · Chautauqua County, Chautauqua County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chautauquacountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The application records details about the waste generator, the process producing the waste, expected quantities, composition, hazards, and previous disposal. It is for an industrial waste stream proposed for treatment or disposal; the form identifies sanitary landfill disposal as an option. It also asks whether waste analysis or a TCLP test is attached and includes certification by representatives of the generator and treatment or disposal facility.
Who needs it
A waste generator representative and a representative of the treatment or disposal facility complete and sign the application for the proposed industrial waste stream.
How to submit it
The form lists the New York State Department of Environmental Conservation, Bureau of Hazardous Waste Operations, at 50 Wolf Road, Albany, New York 12233-4017. The form does not specify a submission method.
About notarization
This document is signed without a notary; the generator representative certifies the information under penalty of perjury, and analysis or TCLP results may be attached.
How to submit this form
- 1
Download the Application
Download the industrial waste treatment or disposal application PDF.
- 2
Complete the Waste Details
Provide information about the generator, process, waste quantities, composition, hazards, and proposed treatment or disposal.
- 3
Gather Supporting Results
Attach waste analysis if available; attach TCLP test results if a TCLP test was conducted.
- 4
Sign and Submit
Generator and facility representatives sign and date the form. It lists the New York State Department of Environmental Conservation address in Albany.
Frequently asked questions
- What information does the industrial waste application request?
- It asks about the generator, waste-producing process, expected production, composition, physical state, hazards, transporter, and proposed treatment or disposal.
- Do I need a notary for the industrial waste application?
- No. The form has no notary block; a generator representative signs and dates its certification under penalty of perjury. Waste analysis or TCLP results may be attached.
- How do I submit the industrial waste application?
- The form lists the New York State Department of Environmental Conservation, Bureau of Hazardous Waste Operations, at 50 Wolf Road, Albany, New York 12233-4017; it does not state a submission method.