Code of Maine Rules
06 - DEPARTMENT OF ENVIRONMENTAL PROTECTION
096 - DEPARTMENT OF ENVIRONMENTAL PROTECTION - GENERAL
Chapter 418 - BENEFICIAL USE OF SOLID WASTES
Appendix 096-418-B - TEMPLATE FOR AUTHORIZATION FORM FOR BENEFICIAL USE
use in conjunction with the requirements of the following sections of this rule:
Section 3(S)
Section 6(B)
Section 10
AUTHORIZATION FORM FOR BENEFICIAL USE
Generator of Secondary Material Beneficial Use Location
Facility Name _________________ Facility Name _______________
Street Address ______________ Street Address ________________
________________________ ___________________________
GPS Coordinates:______________________
Contact Name _______________ Contact Name _______________
Contact phone number ____________ Contact phone number __________
As the generator of the secondary material, I hereby certify that the Department of Environmental Protection has authorized the beneficial use of this secondary material through:
[] beneficial use exemption for no more than 800 tons of construction fill per parcel; or
[] DEP permit-by-rule or license number ______________________
Unless any necessary permit is obtained from the Department, this secondary material may not be placed in the following locations:
* in standing water;
* in a channeled drainage flow;
* in a protected natural resource;
* below the water table; or
* where it may wash into any water of the state.
If the Department issued a permit-by-rule or license authorizing the beneficial use of this secondary material, a copy of the document is attached. The Department license []does []does not include additional conditions for the use of this secondary material that you are required to meet.
________________________ _______________________
Signature of Generator Representative Title
________________________ _______________________
Printed Name Date
As the beneficial user of the secondary material, I hereby certify that I have received this authorization and will comply with the terms of this form and, if applicable, any relevant terms of the beneficial use license for this material. I understand that the secondary material must remain at the location specified above, and that I must either keep this form at the location where the beneficial use occurs, or at my local office for a 3 year period. I understand the form must be made available to the Department upon request.
_____________________ ____________________
Signature of Beneficial User Date
___________________
Printed Name
