Construction and Demolition Debris Processing （建筑和拆迁碎片处理）.pdf

Clear Form 1 CONSTRUCTION DEMOLITION DEBRIS PROCESSING FACILITY ANNUAL REPORT (If you need assistance filling out this form please email swmfannualreport@ or call 518-402-8678.) Complete and submit this form by March 2, 2017. This annual report is for the year of operation from January 01, 2016 to December 31, 2016 SECTION 1 – GENERAL INFORMATION FACILITY INFORMATION FACILITY NAME: FACILITY LOCATION ADDRESS: FACILITY CITY: STATE: ZIP CODE: FACILITY TOWN: FACILITY COUNTY: FACILITY PHONE NUMBER: FACILITY NYS PLANNING UNIT: (A list of NYS Planning Units can be found at the end of this report). NYSDEC REGION #: 360 PERMIT #: (Refer to DEC DATE ISSUED: DATE EXPIRES: NYS DEC ACTIVITY CODE OR Permit) REGISTRATION NUMBER: FACILITY CONTACT: public CONTACT PHONE CONTACT FAX NUMBER: private NUMBER: CONTACT EMAIL ADDRESS: OWNER INFORMATION OWNER NAME: OWNER PHONE NUMBER: OWNER FAX NUMBER: OWNER ADDRESS: OWNER CITY: STATE: ZIP CODE: OWNER CONTACT: