| COMPANY: | SOLID WASTE #: |
SOLID WASTE COLLECTOR ECONOMIC REGULATION QUESTIONNAIRE
Pursuant to NJAC 7:26 H -5.9. Each Solid Waste collector must file this report on a
quarterly basis.
| COUNTY (one county per
page)
|
QUARTER (check one) |
YEAR | |||||||
| 1st | 2nd | 3rd | 4th | ||||||
| 1. Number of Scheduled Residential Customers | (Not from Municipal Contracts) | |
| 2. Number of Scheduled Commercial Customers | ||
| 3. Number of Scheduled Industrial Customers | ||
| 4. Number of On-Call/One Time Customers |
5. List all municipalities, in this county, for which you have
Municipal/Residential contracts and the
approximate number of customers per municipality:
6. For twice-a-week pickup (two 32 gallon cans) residential service (or closest
alternative) what is your
monthly rate (see #1 above).
| Lowest Rate | Highest Rate | Most Common Rate |
7. For a once-a-week pickup (one 2 yard container) commercial service (or closest alternative) what is your monthly rate (see #2 above)
| Lowest Rate | Highest Rate | Most Common Rate |
Certification
I certify under penalty of law that I have personally examined and am familiar with the
information submitted in this document and all attachments and that, based on my inquiry
of those individuals immediately responsible for obtaining the information, I believe that
the information is true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fine and
imprisonment.
| Name: | Title | Date |
THIS FORM MUST BE SUBMITTED WITHIN 20 DAYS AFTER THE LAST DAY OF
EACH QUARTER Failure to file the required forms by the due date will result in a referral
to the Department's Enforcement Office.
IF THERE WAS NO ACTIVITY DURING QUARTER ENTER NONE AS COUNTY
RETURN ADDRESS AND DUE DATES SHOW BELOW:
| New Jersey Department of Environmental
Protection Division of Soid & Hazardous Waste Bureau of Solid WasteRegulation 401 East State Street, 4th Floor West Wing PO Box 414 Trenton NJ 08625-0414 Phone: (609) 984-2080 |
SCHEDULE |