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Scavenger Waste Hauler Discharge Permit Form - Monroe County Department Of Environmental Services Page 2

SCAVENGER WASTE HAULER DISCHARGE PERMIT

County of Monroe Pure Waters District No. _________

Permit No: _________

Expires: _________

Fee:

$30.00

Firm Name

_____________________________________________________

Address

_____________________________________________________

Mailing Address

_______________________________________________

I. The above-named applicant is permitted to discharge specific scavenger waste at the Monroe County

Pure Waters Treatment Facilities thereto applied for by the application dated and verified by the applicant.

The Director of Pure Waters requires the following terms and conditions to govern the permitted

discharges:

1. Submit copy of NYSDEC Part 364 Scavenger Waste Hauler Transporter Permit.

2. This permit allows the discharge of specific Scavenger Waste at locations detailed in the Waste

Hauler Transporter permit issued by the New York State Department of Environmental

Conservation (NYSDEC).

3. Industrial wastes, petroleum tank water and municipal waste water sludge must appear on your

NYSDEC Waste Hauler Transporter permit.

4. Wastes other than domestic waste must be identified at the treatment facilities.

II. The applicant further agrees to:

1. Accept and abide by all provisions of the Sewer Use Law of the County of Monroe and of all

pertinent rules or regulations now in force or shall be adopted in the future.

2. Notify the Director of Pure Waters of any changes in the permit issued by the NYSDEC.

Applicant’s Name (please print) _______________________________ Phone ________________

Applicant’s Signature _________________________________________ Date ________________

Applicant’s Title ___________________________________________________________________

Emergency Contact ___________________________________ Phone _________________________

Renewal Approved by:

_______________________________ Issued this ___ day of _______ 20 ___ .

Michael J. Garland, P.E.

Director of Environmental Services—Pure Waters

Office of Industrial Waste Control

Monroe County Department of Environmental Services

145 Paul Road – Bldg. 1, Rochester, New York 14624 - (585) 753-7600, Option 4, fax: (585) 324-1213

printed on recycled paper

Scavenger Waste Hauler Discharge Permit Form - Monroe County Department Of Environmental Services Page 2