I certify that I am a resident of the Town of Clifton Park, Town of Malta or Town of Halfmoon and that
the waste listed on this form is household generated. That is, the wastes are not from any institutional,
commercial, or inudstrial facilities, or any commercial farming operations. Also, any waste oil being brought
for disposal is household generated and does not contain transformer oils, solvents or chemical products.
For questions or additional assistance with this form, please call Scott Reese - Planning Department at 371-6054
Please fill out ALL information fields
in order to accurately provide us your contact information.