Certification Statement

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.

Choose One: Town of Clifton Park Town of Malta Town of Halfmoon

First Name:
Last Name:
Full Address:
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Mailing Address:
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Daytime Phone:
Evening Phone:
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Items Not Acceptable: appliances, tires, explosives of any kind, microwaves, roofing materials, asbestos materials, machinery and any commercial or farm waste.
Due to changes in the program we will no longer be accepting latex paint.
Please see http://www.dec.ny.gov/docs/materials_minerals_pdf/paint.pdf for latex paint disposal.

Waste Materials
Acids, bases, solvents total cans
Aerosol paints, sprays total cans
Compact Fluorescent light bulbs total number
Driveway sealer total cans
Electronics and computer equipment total number
Fluorescent light tubes total number
Household batteries total number
Mercury and mercury compounds total volume
Paint (oil based) total cans
Pesticides, herbicides, fertilizers total bags
Phones total number
Pool chemicals total cans
Propane tanks total number
Radios total number
Stains, varnish, coatings total cans
TVs total number