FORM A:GENERAL INFORMATION - Required for All Facilities

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

***If you have more than one facility to report on, copy these forms before filling out***

FORM A:GENERAL INFORMATION - Required for all facilities.

Facility Name______Phone______

Facility Mailing Address______

City______State______Zip______

Physical Location of Facility (City/County/State Road)______

______

1/4 / 1/4 Section______Township______Range______or

Latitude (DMS)______Longitude (DMS)______

Facility Owner ______Phone______

Street Address______

City______State______Zip______

Contact Person______Phone______

5.Facility Operator______Phone______

Contact Person______Phone______

Street Address______

City______State______Zip______

5aLand Owner ______Phone ______

Contact Person ______Phone ______

Street Address______

City______State______Zip______

Check the FACILITY TYPE (s) that apply to your operation and complete appropriate forms for EACH facility.

Permitted or Registered Landfill (Forms A, B, F and G)

Transfer Station/Convenience Center (Forms A, C, F and G)

Recycling Facility (Forms A, D, F and G)

Composting Facility (Forms, A, E, F and G)

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM A:GENERAL INFORMATION - Required for all facilities (cont.)

Approximate number of people served by this facility? ______

What are your tipping or disposal fees? ______9. Tipping or disposal fees last year? ______

If any changes were made in the reporting period, that changed the active life of the facility by 25% or more please explain below or in the note section ______

______

What household hazardous waste items do you segregate? (e.g., batteries, paints, pesticides, etc.) ______

______

Do you recycle these items, make them available for reuse, or send them to a hazardous materials disposal facility? ______

______

How many tires were baled at this facility 2004? ______

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM B:REGISTERED AND PERMITTED LANDFILL INFORMATION

Landfill Name______

List All Certified Landfill OperatorsCertification Expiration Date

Landfills with scales report the breakdown and total tons of waste received in Column B below. Landfills that record waste in cubic yards complete the calculations in Column A and report the results in tons in Column B. Column C must be filled in by all landfills.

Column AColumn BColumn C

Cubic Yards (CY) of Material
and Conversion Factors / Amount Received in Tons / Origin of Waste City, County, and State
Residential Waste
CY loose ______x .10 =
CY compacted ______x .25 = / ______Tons
______Tons
Yard or Landscape Waste
CY loose ______x .10 = / ______Tons
Construction and Demolition Waste
CY loose______x .625 = / ______Tons
Commercial Waste - CY
Food waste (loose)______x .45 =
Combustible waste______x .10 =
Non-combustible waste______x .25 = / ______Tons
______Tons
______Tons
Passenger tires ______x .01 =
Tractor/trailer tires______x .05 = / ______Tons
______Tons
Type of special waste______
Total CY______x ______cy/ton= / ______Tons
Other waste______
Total CY______x ______cy/ton= / ______Tons
TOTAL = / ______Tons

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM B:REGISTERED AND PERMITTED LANDFILL INFORMATION (Cont.)

What material is used for daily cover? ______

What material is used for intermediate cover? ______

How many acres had intermediate cover applied during 2004? ______Acres

How many acres had final cover installed during 2004? ______Acres

Is groundwater monitored at the landfill? Yes No If YES, attach results.

Is methane monitored at the landfill?Yes No If YES, attach results.

Is leachate monitored at the landfill?Yes No If YES, attach results.

How many gallons of leachate were generated at your facility?

1s Qtr______2ndQtr______3rd Qtr______4th Qtr______Total______gallons.

Leachate treatment/disposal method______

Calculate the remaining permitted capacity of your landfill in the table below.

Volume
(Cubic yards) / Area
(acres)
Total permitted space available for disposal at the beginning of 2004
Total permitted space used for disposal during 2004
Remaining capacity of permitted disposal space

How many acres, not currently permitted, can be used for future disposal? ______

Describe any closure activities (such as the closing of cells) that occurred in 2004. ______

______

If your facility chips or shreds waste on site, answer the following:

Material Chipped or Shredded Amount (CY or Tons) Amount of Material Used on Site

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM C:TRANSFER STATION/CONVENIENCE CENTER

Facility Name______

List All Certified Transfer Station Operators Certification Expiration Date

Does your facility accept more than 120 cubic yards per day of refuse? (Not including separated recyclable materials) Yes No

Transfer Stations with scales report the breakdown and total tons of waste received in Column B below. Transfer Stations that record waste in cubic yards complete the calculations in Column A and report the results in tons in Column B. Also, complete FORM D for recycled materials.

Column AColumn BColumn C

Cubic Yards (CY) of Material and Conversion Factors / Amount Received in Tons / Amount of Column B that was Recycled
Municipal Solid Waste
CY loose______x .11
CY compacted______x .38 / =______Tons
=______Tons
Industrial Waste
CY loose______x .23 / =______Tons
Construction and Demolition Waste
CY loose______x .625 / =______Tons
Yard Waste
CY loose______x .10 / =______Tons
Treated Medical Waste
CY loose______x .11 / =______Tons
Special Waste Type (s)
Total CY______x ______cy/ton =
Type of special waste______/ =______Tons
Other Waste
Total CY______x ______cy/ton =
Type of other waste / =______Tons
TOTAL / =______Tons

Of the above total, how much was transported:

a. To an out-of-state recycler or processor ______Tons b. To an in-state recycler ______Tons

c. For in-state disposal or ______Tons d. For out-of-state disposal ______Tons

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM D:RECYCLING FACILITY INFORMATION

Facility Name______

List All Certified Recycling Facility Operators Certification Expiration Date

Does the facility process for recycling over 25 tons of material per day? Yes No

Check the box (s) that best describe your operation.

Primary processor: receive public and commercial material, and ship to secondary processor.

Secondary processor: accept loose material and material prepared by primary processor. Further cleans or densify material for shipment to mills.

Broker: connect buyers with sellers, but rarely handle material.

Mill: manufacture an intermediate or final product.

Please complete the following table for your facility. Provide outgoing amounts in Tons if available. If tonnage is not available, complete calculations in Column A and report results in Tons in Column B. Provide the facility name, city, and state in Column C for the destination of each material.

Column AColumn BColumn C

Cubic Yards of Material Received and Conversion Factors / Outgoing Amount (tons) / Sent To:
Facility Name, City/State
Mixed Paper ______x .28 =
OCC ______x .50 =
ONP ______x .43 =
White Ledger ______x .35 =
CPO ______x .50 =
Magazines ______x .50 =
Box Board ______x .50 =
Other Paper ______x .25 =
PET ______x .26 =
HDPE ______x .45 =
Other Plastic ______x .28 =
ANNUAL REPORT QUESTIONNAIRE
Report Period - January 1, 2004 - December 31, 2004
FORM D:RECYCLING FACILITY INFORMATION (Cont.)
Column A / Column B / Column C
Cubic Yards of Material Received and Conversion Factors / Outgoing Amount (tons) / Sent To: Facility Name, City/State
White Goods ______x .08 =
Iron ______x .50 =
Steel/Tin Cans ______x .43 =
Other Metal ______x .43 =
Aluminum ______x .13 =
Other non-ferrous ______x .17 =
Clear Glass ______x 1.00 =
Brown Glass ______x 1.00 =
Green Glass ______x 1.00 =
Mixed Glass ______x 1.00 =
Other Glass ______x 1.00 =
Anti-freeze (gal)______x .0042 =
Carpet Padding ______x .09 =
Tires **
semi-truck______x .05 =
passenger______x .01 =
Motor Oil (gal)______x .0035 =
Lead acid batteries______x .02 =
Cooking Oil (gal)______x .0035 =
Wood Chips ______x .31 =
Pallets ______x .033 =
Asphalt ______x .76 =
Concrete ______x .1.51 =
Other ______
Non-recyclable Waste Disposed
TOTAL
ANNUAL REPORT QUESTIONNAIRE
Report Period - January 1, 2004 - December 31, 2004
FORM D:RECYCLING FACILITY INFORMATION (Cont.)

Based on the above total, please answer the following questions about your facility.
Amount of material processed on facility premises? ______Tons***
Amount of material sent to out-of-state recycler/processor?______Tons
Amount of material sent to in-state recycler/processor? ______Tons
Amount of material sent for in-state disposal? ______Tons
Amount of material sent for out-of-state disposal? ______Tons

Please estimate percentages of the following sources of recyclables material.

______%General Public______%Business______%Government______%Industrial

**Actual number of tires, not CY.

***For the purpose of this report, "processed on facility premises" means that collected recyclable materials are made into new, usable products by the reporting entity.

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM E:COMPOSTING FACILITY INFORMATION

1.Facility Name______

2.List All Certified Composting OperatorsCertification Expiration Date

3. Please check the type of facility: Windrow____ In-Vessel ___ Static Pile ___ Other ___

4.Please answer the following questions about your facility. If your facility has a scale, report the total tons of received material for composting (feedstock). If your facility records waste in cubic yards (CY), complete the calculations below. For chipped brush, grass, leaves, manure and wood fines use .32 for the conversion to tons. For unprocessed yard waste (not chipped) use .10 for the conversion to tons.

How much feedstock was received for composting by the facility during 2004?

CY loose yard waste ______X .10 = ______Tons

CY chipped brush, grass, leaves, manure and wood fines ______X .32 = ______Tons

How much of the feedstock was processed?

CY loose ______X .10 = ______Tons

c. What percentage of the compost was:

Used on site ______Given away ______Sold______Used by your organization______

5.Estimate percentage for each source of feedstock.

Public ______% Commercial (restaurant) ______%

Industrial______% City Parks and Maintenance ______%

Construction ______%Other - Please describe______%

6.List the type(s) and tonnage of feedstock (s) composted at the facility.

______

7.Are Biosolids (Sewage Sludge) used in your composting process? Yes No

a. Do you compost biosolids only? Yes No

b. If you add another feedstock (for example yard waste) please list feedstock (s).

______

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM F:FINANCIAL ASSURANCE FACILITY INFORMATION

What is the current dollar amount of estimated costs for closure, post closure care, or Phase I and Phase II assessments? $______

Did the estimate increase during this reporting year? Yes No If yes, how much? $______

If the cost estimate increased, how much of the increase was caused by the required annual adjustment for inflation? $______

If the cost estimate increased, are the selected financial assurance mechanism(s) still adequate to cover the increase? Yes No Not applicable

What is the amount of acreage used to compute the current estimate? ______

Did the estimated acreage increase during this reporting year? Yes No If yes, how much? ______

Has any activity taken place during this reporting year, such as adding monitoring well(s), that would increase the estimated amount for closure, post closure care, or Phase I and Phase II assessments? Yes No If yes, please explain. ______

Which financial mechanism(s) do you use to assure this facility? Please list the dollar amount for each one.

Mechanism

Amount Assured by Mechanism

Trust Fund / $
Local Government Reserve Fund (LGRF) / $
Local Government Financial Test (LGFT) / $
Local Government Guarantee / $
Insurance / $
Surety (performance) bond / $
Irrevocable letter of credit / $
Financial Assurance not required

If you use a trust fund or LGRF, what is the current balance of the fund? $______

What is the date of most recent payment? ______Amount $______

If you use the LGFT or Local Government Guarantee, does the local government still pass the financial tests based on its most recent audited annual financial report? Yes No

Have you complied with the record keeping and reporting requirements of 20 NMAC 9.1.906.F.4 or 906.H.3? Yes No If no, please explain.

______

ANNUAL REPORT QUESTIONNAIRE

Report Period - January 1, 2004 - December 31, 2004

FORM G:TESTAMENT OF ACCURACY

WORKSHEET - Use this work area to add notes, comments, or clarifications to this report.

______

LIST OF ATTACHMENTS - List any attachments, documents or pages submitted with this report (e.g., monthly records, etc.). Please ensure that each additional page submitted has the facility name on it.

______

TESTAMENT OF ACCURACY - Under penalty of perjury, I hereby attest that the information provided in this report is accurate and complete to the best of my knowledge.

Signature______Date______

Printed Name______

Title______

Phone______