Sample Waste Stream Survey printable pdf download

NOTICE TO CUSTOMERS

You have the right to have a waste stream survey performed by a licensed trade waste removal company or a registered waste broker. The

survey should be completed before entering into an agreement for the collection of your business’ refuse, and the results should serve as a

basis for negotiating a fee for refuse removal. The amount of money that you pay your carting company may depend on the volume of

waste that you leave out for collection and the percentage of that waste that is recyclable. You should monitor your waste collection and

check the accuracy of this survey. Note whether you agree or don’t agree with the survey results next to your initials.

IF YOU DO NOT UNDERSTAND THIS FORM CALL THE

NEW YORK CITY BUSINESS INTEGRITY COMMISSION AT 212-676-6219.

WASTE STREAM SURVEY FORM

Carting Co./Broker __________________________________________________

BIC #

Carting Co. Address

Carting Co. Telephone No.

Fax No.

Customer Name

Telephone No.

Service Location

(NOTE: Calculation of Monthly Volume or Weight is on page 2)

Waste Collected

(See Codes on pg. 2):

Under Enter Amount, enter the number

of bags, dumpsters, or bundles, or

weight of waste.

Surveyor

Customer Initials

Under Unit Type, enter the size, i.e.

Date

Initials & Date

& Date

30B for 30 gal. bag, 55B for 55 gal.

bag, ½Y for ½ dumpster, W for

weight, etc. and indicate “1” for

regular waste and “2” for recyclable

Check (v) the type of waste

next to the size Type

Enter Amount

Unit Type

Example:_____

____ Regular Waste (1)

_______________

____High Grade Paper (2)

____Glass (2)

_30B –1________

_3___________

____Mixed paper (2)

____Aluminum (2)

_55B - 2________

_4___________

____Newspapers, magazines,

____Plastic (2)

_1/2Y - 1_______

and telephone books (2)

____Textile (2)

___ AGREE

_1___________

___ DON’T AGREE

____Cardboard (2)

_____________

_______________

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

___ AGREE

_____________

_______________

and telephone books (2)

____Textile (2)

____Cardboard (2)

___ DON’T AGREE

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

and telephone books (2)

____Textile (2)

___ AGREE

_____________

_______________

____Cardboard (2)

___ DON’T AGREE

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

___ AGREE

_____________

_______________

and telephone books (2)

____Textile (2)

____Cardboard (2)

___ DON’T AGREE

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

___ AGREE

_____________

_______________

and telephone books (2)

____Textile (2)

____Cardboard (2)

___ DON’T AGREE

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

_____________

and telephone books (2)

____Textile (2)

___ AGREE

_______________

___ DON’T AGREE

____Cardboard (2)

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

and telephone books (2)

____Textile (2)

___ AGREE

_____________

_______________

___ DON’T AGREE

____Cardboard (2)

____ Regular Waste (1)

_____________

_______________

____High Grade Paper (2)

____Glass (2)

_____________

_______________

____Mixed paper (2)

____Aluminum (2)

TOTAL

_____________

_______________

____Newspapers, magazines,

____Plastic (2)

___ AGREE

_____________

_______________

and telephone books (2)

____Textile (2)

____Cardboard (2)

___ DON’T AGREE

_____________

_______________

Sample Waste Stream Survey

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