Del. Admin. Code tit. 1, 500, 501, att. F
Reporting Year: 20__ Date:_____________
Facility Identification Type (C&D or All Other) Tons Delivered Average Recovery Rate
I hereby certify that all material recovered from Recyclables delivered to non-DSWA facilities during the course of the year that is the subject of this report and that is reported in the "Tons Recovered" column above was, to the best of my knowledge and after reasonable inquiry, sold or otherwise delivered into the market for commodities recovered from recyclable materials and was not landfilled or otherwise disposed of as solid waste.
I hereby represent that I am authorized to file this statement on behalf of the Licensee, and certify that the above information is true and correct to the best of my knowledge, this ___ day of ___________________, 20___.
____________________________________ ___________________________
Notary Public Signature
Printed Name and Title:_______________________________________
Del. Admin. Code tit. 1, 500, 501, att. F