Nonhazardous Solid Waste Management in Illinois

              SOLID WASTE LANDFILL CAPACITY CERTIFICATION
January 1, 1997
I. Site Information (Please type or print legibly)
a. Site Identification
Name:
FEIN #: Site # (IEPA):
Physical Site Location (Street, Road, etc.):
City, Zip Code: County:
b. Owner/Operator Identification
Owner Name:
Address:
Contact Name:
should be familiar with IEPA solid waste fee reports
Phone #:
Operator Name:
Address:
Contact Name:
should be familiar with IEPA solid waste fee reports
Phone #:
c. Type of Ownership/Operation (Circle Two)
Municipally owned Privately owned
Municipally operated Privately operated
d. Type of Waste Received (mark all that apply)
General Municipal Refuse
Hazardous
Special (Non-hazardous)
Chemical Only (excluding putrescible)
Inert Only (excluding chemical and putrescible)
Other (describe):
The Illinois Environmental Protection Agency is authorized to request this information pursuant to 35 Ill. Adm. Code 858.207(c)
implementing and authorized by Section 22.15(f) of the Environmental Protection Act {415 ILCS 5/22.15(f)(1994)]
II. Permit Information
a. Developmental/Construction Permit:
Permit Number: Date:
b. Other Permit(s):
1. Number: Date:
2. Number: Date:
c. Overall increase (or decrease) of air space in cubic yards allowed by the above permit(s):
1. 2.
d. The total remaining volume of the landfill (air space) in the developmental/construction and other permits
assigned to this site as of January 1, 1997 (in cubic yards):
(1)
III. Remaining Volume Available for Waste Disposal
a. Method and date used for determining the remaining volume (check one and provide date):
survey: date: ; aerial photo: date:
other (describe and date):
b. Remaining permitted volume needed for daily and intermediate cover:
cubic yards (2)
c. Remaining permitted volume needed for final cover:
cubic yards (3)
d. Remaining volume available for waste disposal as of January 1, 1997:
cubic yards (1) (see II.d above)
- cubic yards (2) (see III.b above)
- cubic yards (3) (see III.c above)
= cubic yards (4)
IV. Available Capacity in Terms of “As Received” Waste
a. Average density of waste as received:
number of pounds per cubic “gate yard”
b. Average compaction ratio of waste as it is placed into the fill area
(How many gate yards can you fit into an in-place yard?):
cubic yards (5)
c. Volume of waste as received that can be disposed in the remaining permitted capacity:
cubic yards (4) (see III.d. above)
X cubic yards (5) (see IV.b. above)
= cubic yards (6)
V. Life Expectancy of the Solid Waste Landfill
a. Determine how much solid waste was received at the landfill, in “gate yards”, during the previous 12 months,
January 1, 1996 - December 31, 1996:
cubic yards (7)
b. Determine the number of yeas of life remaining at the current disposal rate:
cubic yards (6) (see IV.c. above)
÷ cubic yards (7) (see V.a. above)
= years (8)
c. Expected closure date for facility:
d. Please describe any adjustments or changes to these numbers.
Note: List any pending permit applications that will increase (or decrease) the landfill capacity and associated air
space increase (or decrease) in cubic yards.
VI. Alternate Method of Determining Available Capacity
a. If an alternate method has been used, please describe:
VII. Signatures
All Solid Waste Landfill Capacity Certifications shall be signed by the person designated below or by a duly authorized
representative of the person:
Corporation - By a principal executive officer of at least the level of vice-president.
Partnership or Sole Proprietorship - By a general partner or the proprietor, respectively.
Government - By either a principal executive officer or a ranking elected official.
A person is a duly authorized representative only if:
1. the authorization is made in writing by a person described above; and
2. is submitted with this certification form (a copy of a previously submitted authorization can be used).
I certify that this document and all attachments were prepared under my direction or supervision. Based on my inquiry of
the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are
significant penalties under Section 44 of the Environmental Protection Act for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Owner Name:
Owner Signature:
date
Title:
Operator Name:
Operator Signature:
date
Title:
Engineer Signature:
Engineer Name:
date
Engineer Address:
Engineer Phone Number: