1. MUNICIPAL RECYCLING PROGRAM PERFORMANCE GRANTS
      1. UNDER SECTION 904 OF ACT 101
      2. THE MUNICIPAL WASTE PLANNING, RECYCLING AND WASTE REDUCTION ACT
      3. OF JULY 1988
    1. CALENDAR YEAR 2016
    2. APPLICATION
      1. Due Date: October 2, 2017
  2. PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
    1. BUREAU OF WASTE MANAGEMENT
    2. DIVISION OF WASTE MINIMIZATION AND PLANNING
    3. www.dep.pa.gov
      1. CHANGES TO AND CLARIFICATIONS FOR THE 904 PERFORMANCE
      2. GRANT PROGRAM
      3. CY2016
      4. PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
      5. BUREAU OF WASTE MANAGEMENT
      6. ACT 101
      7. MUNICIPAL RECYCLING PROGRAM PERFORMANCE GRANT
      8. PROGRAM OVERVIEW
      9. A. Residential Tonnage
      10. DEPARTMENT USE ONLY
      11. Vendor Number:
      12. Invoice Number: 904- -16 Invoice Date:
      13. SAP FUND BUDGET PERIOD GEN. LED. COST CENTER INT. ORDER
      14. 2009500000 20 6600400 3522509000 35250000
      15. TOTAL AMOUNT APPROVED:
      16. APPROVED FOR PAYMENT:
      17. PART II - A: CONTACT INFORMATION
      18. PART II - B: PERFORMANCE INFORMATION
      19. PART II - C: STATEMENT AND VERIFICATION
      20. A. Residential Tonnage
      21. B. Commercial Tonnage

MUNICIPAL RECYCLING PROGRAM PERFORMANCE GRANTS
UNDER SECTION 904 OF ACT 101
THE MUNICIPAL WASTE PLANNING, RECYCLING AND WASTE REDUCTION ACT
OF JULY 1988
CALENDAR YEAR 2016
APPLICATION
Due Date: October 2, 2017

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PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
www.dep.pa.gov
An Equal Opportunity Employer
2520-FM-BWM0013.3
Rev. 3/2017
904

COMMONWEALTH OF PENNSYLVANIA
Department of Environmental Protection
RE:
Act 101, Section 904 Grant Application Information
TO:
All Prospective Act 101 Municipal Recycling Program Performance Grant Applicants
FROM:
Mark Vottero
Municipal Recycling Grants Coordinator
Division of Waste Minimization and Planning
Bureau of Waste Management
Thank you for your interest in recycling and the Act 101 Recycling Performance Grant Program. All Pennsylvania municipalities that
had a recycling program in 2016 may be eligible to apply. The grants are based on the success of your municipality’s recycling efforts.
Performance is judged according to the weight of DEP-approved eligible materials recovered and marketed last year and the population
of your municipality. The grant award can increase as a municipality’s recycling rate grows each year.
To apply, you must have records indicating the types and amounts of materials that were recycled in the previous year. If materials
were recovered from both residential and commercial sources, they must be clearly identified and reported separately. Any residues,
materials not listed as eligible, or any materials that cannot be documented as being generated within your municipality or marketed or
recycled into new products or uses are not eligible for consideration toward your grant.
A standard 15% residue rate will be utilized to calculate residential and commercial residue unless marketed receipts are included with
your grant application. Documentation must be in the form of a signed marketed receipt from the end user containing the amount of
tons recycled in 2016. Grant funds will also not be awarded for glass and plastics that cannot be documented as being recycled in
2016. Materials that are used as daily cover, stockpiled or for resource recovery will not be considered as recycled.
Each year, the department conducts reviews of documentation from a certain number of applicants. If selected, your municipality will be
given at least 30 days notice in order to provide the documentation necessary to support your application, including a list of those
commercial establishments whose recycling figures were counted toward your recycling program. Your grant award will be determined
based on the documentation evaluated at the time of the review. No additional/supplemental documentation will be accepted after the
review is completed. Failure to submit a complete and accurate application may result in a denial of your grant request and possible
enforcement proceedings. Your application is also subject to audit by the Office of Auditor General, Office of the Treasurer, or agents of
those offices. For this reason, you are required to maintain the documentation supporting this grant application for up to four years from
the date the application is submitted.
You are not required to submit the documentation when you submit your application;
however, you may be requested to provide documentation at a later date.
Act 140 of 2006 established prerequisites for the awarding of Act 101, Section 904 Performance Grants. Mandated recycling
communities that apply for the grant, as well as any other municipality (other than a county) awarded more than $10,000 in
performance grant funds must institute certain recycling program components as specified by the act. Any Act 140 municipality that
failed to meet the provisions set forth in this Act will not be considered for funding. Please see the Municipal Recycling Program
Performance Grant Fact Sheet attached in this application for further details on the Act 140 recycling program components.
The application deadline for calendar year 2016 Performance Grants is October 2, 2017. Your application must be received by the
department or post-marked by that date in order to be considered for funding. If your application is being hand delivered, it must be
received by 4 p.m. If your application is submitted after the deadline, it will not be processed and will be returned to you. Please submit
your application to one of the following addresses:
If by U.S. Postal Service:
Department of Environmental Protection
Bureau of Waste Management
P.O. Box 8472
Harrisburg, PA 17105-8472
OR
If by Ground Service (UPS, RPS, etc) or hand delivered:
Department of Environmental Protection
Bureau of Waste Management
14
th
Floor Rachel Carson State Office Building
400 Market Street
Harrisburg, PA 17101-2301
The Performance Grant instructions, frequently asked questions, documentation requirements and examples booklet, and a sample
commercial recycling reporting form is available on the Department’s website at
www.dep.pa.gov
, keyword: Recycling Grants. If you
have any questions regarding the Performance Grant Program or the application procedures, please contact me at
mvottero@pa.gov.
Thank you again for recycling. The DEP looks forward to receiving your application.

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CHANGES TO AND CLARIFICATIONS FOR THE 904 PERFORMANCE
GRANT PROGRAM
CY2016
1. STANDARD RESIDUE RATE
For residential tonnage, municipalities that market some or all of their own material are
not subject to the 15% residue deduction for those materials. “Marketed” means that the
materials were sold to a manufacturer for the purposes of converting the recyclables into
new product. Compensation/rebates from a collector or processor do not count as the
marketing of materials.
Materials that go to a second-hand processor are subject to the 15% residue
deduction—market receipts from that entity cannot be considered as market receipts for
the municipality (the processor cannot “pro-rate” marketed to one or more
municipalities).
For commercial tonnage, materials that go directly from the generator to a market can be
exempt from the 15% rate.
Documentation must include a statement from the
commercial entity or home office of the commercial entity that the materials are directly
marketed without further processing.
Any commercial materials that are sorted
/processed after leaving the generator are subject to the 15% residue rate.
If an application is claiming an overall residue rate of less than 15%, it must describe
why and supply supporting documentation to justify the claim.
2. MULTI-MUNICIPAL APPLICATIONS
Multi-municipal applications under the Act 101, Section 904 Recycling Performance
Grant Program will only be accepted by the Department from the following:
A. Council of governments, consortiums or other similar entities established by two or
more municipalities under 53 Pa.C.S. Ch 23 Subch. A (relating to intergovernmental
cooperation); and,
B. Two or more municipalities where the collection of recyclables has been
accomplished either through a joint bid for services or a joint municipally-operated
collection system (curbside or drop-off) accompanied by a joint recycling education
program.
Any application submitted jointly to the Department by two or more municipalities that
does not meet one of the above criteria will be held until the participating municipalities
supply individual applications. Submittals from county governments are not considered
multi-municipal applications and are therefore not subject to these criteria.

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PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
ACT 101
MUNICIPAL RECYCLING PROGRAM PERFORMANCE GRANT
PROGRAM OVERVIEW
1.
Statutory Authority:
Grants are authorized under Section 904 of the Municipal Waste Planning, Recycling and
Waste Reduction Act (Act 101 of 1988, P.L. 556).
All funds are allocated from the Recycling Fund authorized under Act 101.
2.
Basic Provisions:
Grants are based on available funds under Section 706 and shall be available to all
municipalities that had a recycling program in existence during the previous calendar year.
Eligible applicants are restricted to municipalities as defined in the Act as amended
(i.e., incorporated towns, townships, boroughs, cities, counties, home rule municipalities,
authorities, councils of governments, consortiums, or similar entities established by two or
more municipalities under 53 PA. C.S. Ch. 23 Subch. A (Relating to intergovernmental
cooperation)).
Grants are awarded based on the
weight
of source-separated recyclable materials
identified in Section 1501 of Act 101 that were recycled or marketed in the previous
calendar year and the population of the municipality. These materials include: old
newsprint, high-grade office paper, corrugated paper, other marketable grades of paper,
aluminum cans, steel or bimetallic cans, amber glass containers, green glass containers,
clear glass containers, PET plastics, HDPE plastics, and all other plastics.
Source-separated recyclable materials are materials separated from municipal waste at the
point of origin (home, business, institution) for the purpose of recycling. These include
commingled recyclables and single stream recyclables (recyclables collected together), but
do not include materials recovered from collected loads of municipal solid waste, residual
waste or hazardous waste.
Grant funds will not be awarded for residues, materials not listed as eligible, or any
materials that cannot be documented as being recycled into a new product or use. In
particular, recovered glass that is being stockpiled or used as daily cover at a landfill will
not be considered as recycled. Also, plastics collected and used for resource recovery are
not eligible. Residue includes materials collected but not processable, or materials that
become contaminated through the act of collection, sorting, or processing. The weight of
raw or processed yard waste cannot be claimed under this application. Grants are awarded
only for the eligible materials that were generated within a municipality’s political
boundaries.
A recycling operation/program serving more than one municipality may apportion each
participating municipality’s contribution to its recovery efforts.
The applicant must be able to provide a breakdown of materials collected from residential
and/or commercial sources. If the breakdown is estimated, the basis for the estimate must
be identified by the applicant.

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3.
Application Procedures:
Applications delivered and postmarked by the announced deadline will receive grant credit
for all eligible materials recycled and marketed in the previous calendar year. Applications
submitted after the deadline will be returned.
The DEP will notify each applicant of its receipt of the application. If notification is not
received, please call the department at 717-787-7382.
Applicants must be able to substantiate:
-
That recycled material was source separated;
-
That recycled material was generated within the municipality’s borders;
-
The quantity of material recycled and marketed (in pounds and/or tons-not cubic
yards) in the previous calendar year;
-
The quantity of non-recyclable residue removed through processing; and
-
That recycled material was not landfilled, reused in the same form, or used for energy
recovery.
Documentation for all tonnage claims must be supported by actual records (i.e., weight
slips or receipts from each hauler or market verifying all tonnage claims). These records
should NOT be submitted with the application, but must be on file with the municipality and
be available to the department upon request. Records documenting the weight of materials
claimed in this application must be retained by the applicant for four (4) years from the end
date of the year the materials were recycled and marketed.
4.
Grant Limitations:
A county applicant may receive no more than 10 percent of the funds available under this
grant in any fiscal year.
A grant will not be awarded to any county or municipality that has failed to comply with the
conditions set forth in previously awarded grants, the grant requirements of Act 101, or the
regulations of the act.
The availability of grants is contingent upon the availability of monies in the Recycling
Fund.
Act 140 of 2006 established performance requirements for Recycling Performance Grant
applicants. Mandated municipalities that apply for the grant as well as any other
municipalities (except for counties) that receive or have received in excess of $10,000,
must meet the following performance requirements:
?
Require, through ordinance, that all residents have waste and recycling service.
?
Have an implemented residential recycling program and facilitates a commercial
recycling program or participates in a similar county or multi-municipal program.
?
Have a residential and business recycling education program.
?
Have a program of enforcement that periodically monitors participation, receives
complaints and issues warnings for required participants and provides fines, penalties,
or both, in its recycling ordinance.
?
Have provisions, participate in a county or multi-municipal program or facilitates a
private sector program for the recycling of special materials.
?
Sponsor a program, facilitate a program or support an organization to address illegal
dumping and/or littering problems.

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?
Have a person or entity designated as recycling coordinator who is responsible for
recycling data collection and reporting recycling program performance in the
municipality or municipalities.
Municipalities that have not achieved the performance requirements listed above and are
now obligated to meet the requirements of Act 140 due to this grant application will be
notified in writing by the department and must use the awarded performance grant funds to
comply with those requirements. If any component of Act 140 has not been implemented by
the next grant submission, the municipality will not be considered for a recycling grant.
All grants are subject to audit by the department, the Office of the Auditor General, the
Office of the Treasurer, and their agents. Any tonnage not properly documented at the time
of audit will not be credited toward a municipality's Performance Grant Award. No
additional/supplemental documentation will be accepted after the review is completed.
Failure to submit a complete and accurate application may result in a denial of your grant
request and possible enforcement proceedings.
5.
Grant Award Formula:
Grant awards will be calculated as follows:
Base Award = Approved Residential Tonnage + Approved Commercial Tonnage x $5
* Approved Tonnages cannot include any residues. Approved commercial tonnage for
the base award cannot exceed the approved residential tonnage.
Bonus Award =
Approved Residential Tonnage + Approved Commercial Tonnage x Municipality’s
Recycling Rate X $1
* Approved Tonnages cannot include any residues. Approved commercial tonnage for
the bonus award cannot exceed the approved residential tonnage. A municipality’s
recycling rate is determined in this manner:
Approved Residential Tonnage + Approved Commercial Tonnage/(municipality’s
population x 0.8) x 100
Where 0.8 tons/person/year is the average state-wide waste generation rate.
Approved commercial tonnage for the Recycling Rate calculation cannot exceed the
approved residential tonnage.
Commercial Incentive =
Documented Commercial Tonnage in excess of that approved for base and bonus
award x $10
Total Award = (Base Award + Bonus Award + Commercial Incentive) X 60%

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Instructions for
Filing the Application for
Act 101, Section 904
Municipal Recycling Program Performance Grants
A.
GENERAL INSTRUCTIONS
1.
Read all instructions carefully before completing your application. Failure to submit
required information will result in a delay in payment.
2.
Only include the weight of
eligible materials
. Eligible materials include old
newsprint, high-grade office paper, corrugated paper, other marketable grades of
paper, aluminum cans, steel or bimetallic cans, amber glass containers, green glass
containers, clear glass containers, PET plastics, HDPE plastics, and all other
plastics. Materials not eligible include motor oil, scrap metals, white goods, tires, and
yard wastes.
All materials claimed must be:
Source separated;
Post consumer;
Generated within the boundaries of the local government applicant;
Diverted from the
municipal
waste stream; and
Recycled or marketed in 2016.
Post-Consumer Materials
refer to recovered materials that have been used as a
consumer item and are diverted from municipal solid waste for the purpose of
collection and recycling. The term excludes materials generated in manufacturing
and converting processes such as manufacturing scrap and trimmings/cuttings. Also,
print overruns, over issue publications, and obsolete inventories that did not leave
the generating facility would be classified as pre-consumer materials.
Residual waste
materials from a manufacturing process
are ineligible
and are not
to be included.
3.
Gather all documentation needed to support the weight of the
eligible
materials
claimed in the application. Review all documentation and determine if it is valid.
(Refer to the booklet on Documentation Requirements and Examples). Separate any
invalid documentation and do not include it in the application; or, try to obtain valid
documentation to replace the invalid documentation
prior
to completing the
application. Although the documentation is not required to be submitted with the
application
,
the
applicant must have valid documentation on file to support all
tonnage claimed prior to submission of application. All documentation for this
application must be maintained by the applicant for four (4) years from the end
date of the year the materials were recycled and marketed.
In the event of an
audit, any tonnage not substantiated by valid documentation at the time of the audit
will be disallowed and the grant award will be adjusted. No additional/supplemental
documentation will be accepted after the review is completed. Failure to submit a
complete and accurate application may result in a denial of your grant request and
possible enforcement proceedings.

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4.
Using the valid documentation gathered as instructed in #3 above, calculate the total
number of tons of each eligible residential and commercial material recycled and
marketed by your municipality during the calendar year covered by the application.
You will need this information to determine the total number of eligible residential and
commercial tons to be reported in PART II-C, #1 of the application, and to report the
weight of each eligible material in PART III A & B of the application.
5.
The completed application must be submitted to the Pennsylvania Department of
Environmental Protection, Bureau of Waste Management, Waste Reduction
& Recycling
Section,
P.O.
Box 8472,
Harrisburg,
PA
17105-8472,
by
October 2, 2017. If your application is hand delivered, it must be received by 4 p.m.
Any applications delivered or postmarked after the deadline will not be processed
and will be returned to the applicant.
A completed application consists of:
1. Part I – Application Information
2. Part II A – Contact Information
3. Part II B – Performance Information
4. Part II C – Statement and Verification
5. Part III A & B – Tonnage Summary Form
6. Part IV – W-9 Form, Request for Taxpayer Identification Number and
Certification
Make sure you are using the most current version of the application.
You can
determine this by looking at #5 on the first page of the application. It will indicate the
application is for the Calendar Year 2016.
Only forms
provided by the department
may be used in completing this application.
B.
PART I - APPLICANT INFORMATION
1.
APPLICANT: Enter the name of the municipality applying for the grant. Only
municipalities as defined in Act 101, as amended, are eligible for grants (i.e., county,
city, township, incorporated town, borough, home-rule municipality, authorities, COGs,
consortiums, or similar entities). If the recycling program is a joint effort of several
municipalities, a lead municipality must submit the application on behalf of all of the
participating municipalities. No municipality should be included in more than one
application. COGs, consorting, or similar entities must submit proof of their
establishment under 53 Pa.Cs.Ch.23 Subch A.
2.
OFFICIAL BUSINESS ADDRESS: Enter the Applicant’s Box Number, Street Address
and City or Town.
3.
COUNTY: Enter the Applicant’s County.
4.
FEDERAL I.D. NUMBER: Enter the applicant’s federal I.D. number.

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C.
PART II A – CONTACT INFORMATION
1.
Question #5, Population: Enter the applicant’s population as determined by the 2010
decennial census.
If this is a multi-municipal application,
the total populations of all
participating municipalities must be used and a
separate sheet must be attached
listing the participating municipalities and their populations.
For counties
operating a drop-off recycling program, the total county population must be used
(unless it can demonstrate which municipalities are not participating in the drop-off
program).
Please enter, in the upper right hand corner of the page, your municipality’s name and the
county in which your municipality is located.
PART II B - PERFORMANCE INFORMATION
1.
Total Tons of Eligible Materials Recycled:
a)
Residential Tons:
Enter the total tons of
eligible
material recycled and marketed
from the municipality’s residential recycling program during the 2016 calendar
year. (Refer to #2 of the General Instructions for eligible material requirements.)
Please round this number to the nearest tenth (0.1) of a ton.
(Please Note:
Recyclables generated in multi-family dwellings are considered “residential” even
if they were collected by a “commercial” hauler.) The total amount of residential
tons claimed must be substantiated by valid documentation. (Refer to the booklet
on Documentation Requirements and Examples.)
b)
Residential Residue:
Enter the amount of non-recycled residue which was a part
of the total residential tons. This is material collected with the recyclables but was
not recycled. DEP uses a 15 percent average to calculate residue. If you use a
rate other than 15 percent to calculate the residential residue, you
must
have
marketed receipts to verify the rate you used. Documentation must be in the form
of a signed market receipts statement from the end user containing the amount of
tons or the percent of residue to be deducted from the total residential tons
collected for the calendar year under consideration.
If you leave this space
blank, the department will automatically deduct 15 percent from the
residential tons claimed.
c)
Commercial Tons:
Enter the total tons of
eligible
commercial (including
municipal & institutional) materials recycled and marketed from commercial
establishments within the municipality in the 2016 calendar year. (Refer to #2 of
the general instructions for eligible material requirements.) Please round the
number to the nearest tenth (0.1) of a ton. The amount claimed must be
substantiated by valid documentation. (Refer to the booklet on Documentation
Requirements and Examples.)
d)
Commercial Residue:
Enter the amount of non-recycled residue which was a
part of the total commercial tons. This is material collected with the recyclables but
was not recycled. The department uses a 15 percent average to calculate residue.
If you use a rate of other than 15 percent to calculate the amount of non-recycled
commercial residue, you
must
have marketed receipts to verify the rate used.
Documentation must be in the form of a signed marketed receipts from the end
user containing the amount of tons of commercial residue or the percent of
residue of the total commercial tons collected for the calendar year under
consideration.
If you leave this space blank, the department will automatically
deduct 15 percent from the commercial tons claimed.

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e)
Total Tons:
Enter the total tons of eligible material in the space provided.
PART II C – STATEMENT AND VERIFICATION
The application must be signed by an authorized official of the municipality or county
applying for the grant.
D.
PART III - TONNAGE SUMMARY FORM A & B
Please enter, in the upper right hand corner of the page, your municipality’s name and the
county in which your municipality is located.
You are not permitted to substitute your own form in Part III A & B. Please use the form
provided in this application.
FORM A: List, by hauler or market (or from the entity that is supplying you the
documentation), the total tons of each eligible residential material recycled and marketed
on behalf of your municipality in the 2016 calendar year. If you have more than one piece of
documentation from a particular hauler or market, you may summarize them on one line
rather than listing each report or weight ticket separately (i.e. if you receive monthly reports
from a recycling collector, you do not have to list that collector and the total of each report
twelve times on the form - you may list that collector only once and record the total of the
twelve monthly reports for each material on that line). You should calculate the total for
each hauler or market, the total for each material and the total residential tons recycled by
all of your haulers or markets.
FORM B: List, by hauler or market (or from the entity that is supplying you the
documentation), the total tons of each eligible material recycled and marketed on behalf of
your municipality in the 2016 calendar year from commercial, institutional or municipal
establishments. If you have more than one piece of documentation from a particular hauler
or market, you may summarize them on one line rather than listing each report or weight
ticket separately (i.e. if you receive monthly reports from a recycling collector, you do not
have to list that collector and the total of each report twelve times on the form - you may list
that collector only once and record the total of the twelve monthly reports for each material
on that line). You should calculate the total for each hauler or market, the total for each
material and the total commercial tons recycled by all of your haulers or markets.
Please refer to the attached example on Page 9 for guidance in completing these forms.
Old newsprint is comprised of newspapers offered for circulation (i.e. delivered to homes,
businesses, newsstands, etc.) and later collected for recycling.
Other marketable grades of paper includes magazines, telephone books, kraft bags and
any post-consumer paper fiber not suitable for inclusion under another category.
Aluminum, steel or bimetallic cans includes containers (primarily food and beverage cans)
originating from homes, businesses and institutions. These categories do not include scrap
metal (aluminum furniture, stainless steel, iron scrap, 55 gallon drums, etc).
Commercial tonnages are those generated by businesses, institutions (hospitals, nursing
homes, schools etc.) and municipal (government offices, libraries, etc.) establishments.
If the eligible materials were collected and marketed as commingled materials (two or more
eligible materials collected together), then place the total tons of those materials in the
space provided for commingled residential or commingled commercial tons. In this case
you are not required to determine the tonnage of each material separately.
LIST THE

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MATERIALS INCLUDED IN THE COMMINGLED TONNAGE IN THE SPACE PROVIDED
at the bottom of the Tonnage Summary Form. The above should also be followed for single
stream materials.
The
weight
of the eligible
residential materials must be reported separately from the
weight of the eligible commercial materials. All weights must be in tons.
The Total Residential Tons and the Total Commercial Tons reported on the Tonnage
Summary Forms must match the total eligible residential and commercial tons reported in
PART II B, #1 of the application.

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Anyplace Twp., Where Co.
Municipality, County
PART III - TONNAGE SUMMARY FORM
A. Residential Tonnage
Business
Hauler/Market
Old Newsprint
High Grade
Office Paper
Corrugated
Other
Marketable
Grades of
Paper
Mixed Paper
Aluminum Cans
Steel or
Bimetallic Cans
Mixed Cans
(not scrap
metals)
Amber Glass
Clear Glass
Green Glass
Mixed Glass
PET Plastics
HDPE Plastics
Other Plastics
Mixed Plastics
Commingled*
Single Stream*
Total
ABC hauling
301.4
15.1
28.9
52.3
397.7
Ron's Recycling
157.2
77.0
41.8
276.0
Boy Scouts
189.5
189.5
Ambassador
Apartments
10.2
1.7
3.6
15.5
Totals
501.1
157.2
77.0
15.1
28.9
1.7
55.9
41.8
878.7
Total Residential Tons
878.7
*If claiming residential commingled or single stream tonnage, use the space below to list the materials included in the tonnage:
Ron's Recycling collects all glass, aluminum and steel cans as commingled.

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E.
PART IV - FORM W-9
Complete this form according to the instructions provided with the form and attach it to the
application. Payment cannot be made without submittal of this form. Also, the Name, Address and
I.D. Number reported on the Form W-9 must match the applicant name, address and federal I.D.
number reported in PART I of the application.

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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
Application for Municipal Recycling Program Performance Grant
The Pennsylvania Municipal Waste Planning, Recycling and Waste Reduction Act,
Act 101 of 1988 (P.L. 556) Section 904
PART I - APPLICANT INFORMATION
PLEASE FOLLOW ALL INSTRUCTIONS AS PROVIDED
1. APPLICANT:
NUMBER - BOX
2. OFFICIAL BUSINESS ADDRESS:
STREET
CITY
TOWN
STATE
ZIP CODE
P
A
3. COUNTY:
4. FEDERAL I.D. NUMBER:
5. FOR CALENDAR YEAR:
2
0
1
6
DEPARTMENT USE ONLY
Vendor Number:
Invoice Number: 904-
-16
Invoice Date:
SAP FUND
BUDGET PERIOD
GEN. LED.
COST CENTER
INT. ORDER
2009500000
20
6600400
3522509000
35250000
TOTAL AMOUNT APPROVED:
APPROVED FOR PAYMENT:
Sign Here
Date

2520-FM-BWM0013.3
Rev. 3/2017
- 2 -
Municipality, County
2016
PART II - A: CONTACT INFORMATION
Directions: Please answer the questions below. Attach additional pages if necessary. Please type or print all entries.
DO NOT LEAVE ANY QUESTION BLANK.
1.
Contact Person for this application:
Name of individual or company that compiled/completed this application (if different than above):
2.
Contact Person Telephone Number: (
)
Fax Number: (
)
Days of the Week and Times you may be contacted at above telephone number:
3.
Contact Person Email Address:
4.
Applicant's Designated Recycling Coordinator (if different than #1 above):
Telephone Number: (
)
Email Address:
5.
Population (per the
2010
Decennial Census):
Participating Municipalities:
6.
Municipality website address:
Mucni

2520-FM-BWM0013.3
Rev. 3/2017
- 3 -
Municipality, County
2016
PART II - B: PERFORMANCE INFORMATION
1.
TOTAL TONS OF ELIGIBLE MATERIALS RECYCLED: Use totals from Part III A & B - Tonnage Summary Forms
to list the total tons of material recycled by your municipality for the calendar year covered by this application.
Enter all figures in TONS. Round to the nearest tenth (0.1) of a ton.
Residential
Residential
Commercial
Commercial
Tons
Residue*
Tons
Residue*
TOTAL TONS
-
+
-
=
*Residues are materials collected and weighed with recyclables but are not recycled. See Section C. Part II C 1. (b) and
(d) of the instructions for more information.
2.
If you are claiming a residue of less than 15 percent of the total Residential and/or Commercial tons recycled,
Please include signed market receipts with your grant applications..
3.
If the totals of materials listed in #1 above is greater or less than the amount collected in the previous year, list
those factors that could account for the difference.
PART II - C: STATEMENT AND VERIFICATION
The information contained in this application is true and correct to the best of my personal
knowledge or information and belief.
I also understand the requirements of both Act 101 and Act 140. I hereby acknowledge that all
of the requirements are being met by all municipalities participating jointly in this application (this
statement is only applicable to those municipalities required to meet the requirements of one or both
Acts).
This statement and verification is made subject to the penalties of 18 Pa. C.S.A § 4904 relating
to unsworn falsification to authorities, which provides that if I make knowingly false averments, I may
be subject to criminal penalties.
Signature
of
Elected/Appointed
Municipal
Official
Title
Date

2520-FM-BWM0013.3
Rev. 3/2017
2016
- 4 -
Municipality, County
PART III - TONNAGE SUMMARY FORM
A. Residential Tonnage
Business
Hauler/Market
Old Newsprint
High Grade
Office Paper
Corrugated
Other
Marketable
Grades of Paper
Mixed Paper
Aluminum Cans
Steel or
Bimetallic Cans
Mixed Cans (not
scrap metals)
Amber Glass
Clear Glass
Green Glass
Mixed Glass
PET Plastics
HDPE Plastics
Other Plastics
Mixed Plastics
Commingled*
Single Stream*
Total
Totals
Total Residential Tons
*If claiming residential commingled or single stream tonnage, use the space below to list the materials included in the tonnage:

2520-FM-BWM0013.3
Rev. 3/2017
2016
- 5 -
Municipality, County
PART IZII - TONNAGE SUMMARY FORM
B. Commercial Tonnage
Business
Hauler/Market
Old Newsprint
High Grade
Office Paper
Corrugated
Other
Marketable
Grades of
Paper
Mixed Paper
Aluminum Cans
Steel or
Bimetallic Cans
Mixed Cans
(not scrap
metals)
Amber Glass
Clear Glass
Green Glass
Mixed Glass
PET Plastics
HDPE Plastics
Other Plastics
Mixed Plastics
Commingled*
Single Stream*
Total
Totals
Total Commercial Tons
*If claiming commercial commingled or single stream tonnage, use the space below to list the materials included in the tonnage:





Bureau of Waste Management
P.O. Box 8472
Harrisburg, PA 17105-8472

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