FY 2015 PROCESSORS LICENSE APPLICATION
INSTRUCTIONS: This is an application to process recyclables or compostables generated within the Chittenden Solid Waste District
(CSWD). Licenses expire annually on July 1. Complete a separate application for each site (i.e., facilities located at different addresses).
Please complete both sides of this form and return with a check or money order in the amount of $10.00 for each facility listed (if
applicable --see below), made payable to CSWD, to: Chittenden Solid Waste District, 1021 Redmond Rd., Williston, VT 05495.
APPLICANT INFORMATION
BUSINESS NAME: _______________________________________________________________________________________________
OWNER NAME(S):_______________________________________________________________________________________________
MAILING ADDRESS: ______________________________________________________________________________________________
BUSINESS ADDRESS IF DIFFERENT: __________________________________________________________________________________
LOCAL CONTACT PERSON: _________________________________EMAIL:__________________ ______PHONE #: _________________
FACILITY OPERATOR: _____________________________________EMAIL:________________________ PHONE #: _________________
FACILITY INFORMATION
TYPES OF MATERIALS PROCESSED:
Paper
___Boxboard
___Corrugated cardboard
___Paper bags
___Magazines & catalogs
___White & colored paper
___Newspaper
___Phone directories
___Books
___Other: ________________
Plastic
___ Bottles
___ Mixed
___ Film
___Other: ________________
Compostables
___Food scraps
___Soiled paper
___Yard trimmings
Metal
___Aluminum cans
___Steel/tinned cans
___Scrap metal
Glass
___Bottles & jars
___Other: ________________
C&D Debris
___Untreated wood
___Asphalt
___Brick
___Concrete
___ Other: ________________
Other Materials
Was the facility in operation prior to and on November 1, 1992 and continuously since?
____Electronics
____Textiles
____Tires
____Tree Limbs, brush, stumps
____Other: ________________
YES ______
NO ______
If yes, does the facility and operator have all necessary permits, licenses, and approvals from the State and local regulators, and are they
in compliance with those permits, licenses, approvals, and other applicable laws and regulations?
YES ______
NO ______
If you answered yes to both questions, you are not required to pay the licensing fee.
Licensing fees must be paid by check or money order made out to CSWD.


FOR DISTRICT USE: Approved: YES ____ NO ____

Date: _______________ By: _______
CERTIFICATIONS
I certify and agree to the following:
1.
The undersigned has obtained (or will obtain prior to commencing activities under the License) and agrees to abide
by and maintain all necessary permits and licenses from the State and all agencies thereof, and all applicable
member municipalities of the Chittenden Solid Waste District (CSWD).
2.
The undersigned’s facility is included in CSWD’s Solid Waste Management Plan.
3.
The undersigned and the undersigned’s employees and personnel will comply with all pertinent ordinances and
regulations of the Chittenden Solid Waste District and any rules governing use of District facilities. I understand that
failure to comply may result in suspension or revocation of the License and/or other penalties.
4.
The undersigned is not delinquent in payments owed to CSWD, and the required License fee has been paid.
5.
The undersigned employees and personnel have received the education and training necessary to safely and
properly conduct the undersigned’s activities under the License.
6.
The undersigned financial resources are adequate to allow the undersigned to safely and properly conduct the
undersigned’s activities under the License.
7.
The undersigned’s activities under the License will not unduly pollute any element of the environment nor impose
any undue burden upon any element of the community. A permit issued by a State agency identifying findings shall
be considered satisfactory evidence that this condition is met.
8.
The undersigned indemnifies and holds harmless CSWD from any and all claims, damages, losses, and expenses
(including attorneys’ fees) to the extent caused by the undersigned’s performance under the License or the
performance by any agents, officers, subcontractors, employees, or personnel of the undersigned at facilities
owned, leased, or operated by CSWD.
9.
The undersigned shall report to CSWD the quantities of recyclables shipped and materials composted for solid waste
generated in CSWD for the periods January 1 through June 30 and July 1 through December 31 of each calendar year
while operating under the License. The required data shall be submitted within thirty (30) days of the end of each
reporting period on forms provided by CSWD or by providing copies of reports required by the State for solid waste
facility certification.
10.
To the best of the undersigned’s knowledge, the information provided on this application and all accompanying
documents is true, accurate, and complete.
___________________________________________
Business Name
___________________________
Date
___________________________________________
Signature of Owner or Designee
____________________________
Title
Processor’s License – page 2