Customer’s Name

County Represented

Customer’s Address

Email Address

Phone #

Customer’s Position in County

Municipal Solid Waste (MSW) generated

(Tons per Day) (Tons per Year)

Tipping Fee ($/Ton)

Do you own your own landfill? Yes No

If no, who owns the landfill?

Do you manage your landfill? Yes No

Landfill Manager Name

Landfill Manager Email

Landfill Manager Phone

Are you in a Regional Landfill Authority with other counties? Yes No

If yes, please list counties

Do you get Municipal Solid Waste from other counties? Yes No

If yes, please list counties

Is there a natural gas transmission line or gathering gas line in the landfill area or near your existing landfill? Yes No

Gas Supplier