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Organization Information
Entity Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Entity Type
Contact Information
Name
First Last
Position
Email
Phone
Reason for Interest
How Can We Help?
Proposed Facility Location
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Site Availability
Is a site currently available?
- Yes
- No
If yes, where is it located?

Site Configuration

Total Acreage	Building Square Footage if Applicable	Zoning

If a building exists, how was it previously used?
Waste Stream
How many secure waste streams do you have currently?
Source One
Source Name How Long (Years) Volume (Tons/Year) Tip Fee ($ Per Ton) Type (W,R,O,M) Origin (R,C,I)

Waste Type: W=Waste, R=Separated Recyclables, O=Yard/Organic, M=Mix Stream
Waste Origin: R=Residential, C=Commercial, I=Industrial
Is a waste characterization or profile available for any of the source waste streams?
- Yes
- No
If YES, please identify which source:
Business Structure
What business structure is being considered?
Describe

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