Fillable SLUDGE DISPOSAL QUARTERLY REQUEST FORM Municipal Wastewater Treatment (Loudoun County Government)

Fill Online, Printable, Fillable, Blank SLUDGE DISPOSAL QUARTERLY REQUEST FORM Municipal Wastewater Treatment (Loudoun County Government) Form

Use Fill to complete blank online LOUDOUN COUNTY GOVERNMENT (VA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SLUDGE DISPOSAL QUARTERLY REQUEST FORM Municipal Wastewater Treatment (Loudoun County Government)

On average this form takes 7 minutes to complete

The SLUDGE DISPOSAL QUARTERLY REQUEST FORM Municipal Wastewater Treatment (Loudoun County Government) form is 1 page long and contains:

  • 1 signature
  • 9 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Loudoun County Government

BROWSE LOUDOUN COUNTY GOVERNMENT (VA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
LOUDOUN COUNTY SOLID WASTE MANAGEMENT FACILITY
801 SYCOLIN ROAD, PO BOX 7100, SUITE 300
LEESBURG, VIRGINIA 20177
SLUDGE DISPOSAL QUARTERLY REQUEST FORM
Municipal Wastewater Treatment Plant
This form shall be used to request permission on a quarterly basis to dispose at the Loudoun County Landfill of
sludge generated by a Municipal Wastewater Treatment Plant. Please fill out Sections A, B, and C below and
transmit the completed form by fax to 703-771-5523 or by email to the landfill manager at OSWM@loudoun.gov.
NOTE THAT A VALID LANDFILL ACCOUNT CARD MUST BE PRESENTED TO THE SCALEHOUSE AT THE TIME OF
SLUDGE DELIVERY.
SECTION A – Requestor Information
Requested Quarter for Sludge Disposal:
Year:
Name of Requesting Municipality:
Mailing Address:
Contact Person:
Title:
Telephone:
Fax:
Email:
SECTION B – Generator Information
Name of Generating Facility:
Facility Address:
Total Quantity of Sludge to be Disposed during Quarter (tons):
Landfill Account No.:
Total Quantity of Sludge to be Dispose of per Day (tons):
SECTION C – Generator Certification
Please answer the following questions for the total quantity of sludge for which you are requesting disposal:
1. Is the sludge stabilized?
YES
NO
OTHER ___________________________________________________________
2. Is the sludge stabilized, dewatered to a level of 20 % or more, and will pass the paint filter test?
YES
NO
OTHER ___________________________________________________________
3. Is the sludge non-hazardous according to the current Virginia regulations governing the management of hazardous
waste in the Commonwealth?
YES
NO
OTHER ___________________________________________________________
I certify that I have personally examined and am familiar with the information submitted on this form, and I believe that the
submitted information is true, accurate, and complete.
Name of Responsible Official:
Title:
Signature:
Date:
FOR OFFICIAL USE ONLY – COUNTY APPROVAL
This request for disposal at the Loudoun County Landfill of municipal wastewater treatment plant sludge has been reviewed
to ensure conformance with County policy and is hereby granted for the daily quantity and timeframe indicated below.
Approved Disposal Quantity per Day (tons):
Approved Disposal Dates:
Name of County Representative:
Title:
Signature:
Date:
Select Quarter
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SLUDGE DISPOSAL QUARTERLY REQUEST FORM Municipal Wastewater Treatment (Loudoun County Government)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document