1. TRAVEL REQUEST FORM

2500-FM-BWM0219 Rev. 2/2011
COMMONWEALTH OF PENNSYLVANIA
Form
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
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TRAVEL REQUEST FORM
To be submitted for approval of all travel costs occurring outside of the Commonwealth and exceeding $300 or
exceeding 300 miles from the grantee’s or applicant’s place of business.
BOTH SIDES OF THIS FORM MUST BE COMPLETED AND FORWARDED TO THE APPROPRIATE DEP
REGIONAL OFFICE AT LEAST FOUR WEEKS PRIOR TO DEPARTURE.
1. MUNICIPALITY
2. COUNTY
3. PROGRAM #
--
--
4. GRANT CONTRACT #
5. CONTACT PERSON
6. STREET/BOX #
CITY
, PA ZIP
TELEPHONE # (
)
7. DATE(S) OF TRAVEL
NAME(S) OF PERSONS TRAVELING
RELATION TO MUNICIPALITY
8. DESTINATION
FROM
TO
MILES TO BE TRAVELED (ONE WAY)
9. METHOD OF TRANSPORTATION ESTIMATED COST
(Check all that apply)
Plane
Transportation
$
Railroad
Lodging
$
Municipal or Personal Vehicle
Conference Fees $
Other (Specify)
Miscellaneous
$
Other
$
TOTAL
$

2500-FM-BWM0219 Rev. 2/2011
Form
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10. PURPOSE (Explain in detail, attaching supporting documentation as appropriate)
FOR DEP USE ONLY
REGIONAL OFFICE
CENTRAL OFFICE (Exceeding $300)
Approved
Approved
Disapproved
Disapproved
Regional Planning & Recycling Coordinator
Central Office Contact
Date
Date

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