Town of Wilton
Town of Moreau
Town of Saratoga
Village of Victory
Village of Schuylerville
Town of Northumberland
Village of South Glens Falls
Special Collection Day for Household Hazardous Wastes
Date: Saturday, September 17, 2011
Time: 8:30 AM to 3:30 PM (each registrant will be assigned a specific time)
Location: Wilton Town Hall Highway Garage, 20 Traver Road, Wilton, NY
Please Read Carefully. Retain this instruction sheet for your reference.
In order to participate in the Special Collection Day:
1. Fill out the registration information.
2. Estimate the quantities of waste types that you want to dispose.
3. Sign and date the form. If e-mailing the form, your typed name constitutes your signature.
4. Your completed form is subject to approval by the Special Collection Day Project Committee.
Eligible materials will be registered for collection.
A copy of the form will be returned to you with your assigned time; You must bring it to the collection site.
Items highlighted or crossed out on the returned form are NOT ACCEPTABLE items.
NON-ACCEPTABLE ITEMS INCLUDE:
LATEX PAINT
TIRES, MICROWAVES, AIR CONDITIONERS, APPLIANCES,
SMOKE DETECTORS, PROPANE TANKS, FIRE EXTINGUISHERS
5. Return the form no later than Monday, September 5, 2011 by mail or in person to:
Household Hazardous Waste Collection Day
Northumberland Town Hall
17 Catherine Street
PO Box 128
Gansevoort, NY 12831
The returned form must be brought to the site on September 17, 2011.
For more information or assistance with this form, please call The Town Hall at (518) 792-9179.
For additional forms, please see www.townofnorthumberland.org
DIRECTIONS TO DROP OFF SITE:
From the North:
Take I87 South and get off at Exit 16. Take a right at the exit traffic light onto Ballard Road. Go to the next traffic light
and take a left onto Traver Road. The Wilton Town Hall/Court/Highway Department Complex is located on the right
at 22 Traver Road.
From the South:
Take I87 North and get off at Exit 16. Take a left at the Exit light onto Ballard Road. At the second traffic light turn
left onto Traver Road. The Wilton Town Hall/Court/Highway Complex is located on the right at 20-22 Traver Road.
You will be directed where to enter and exit. YOU MUST STAY IN YOUR VEHICLE AT ALL TIMES.
Print Form
TOWN OF NORTHUMBERLAND
2011 Household Hazardous Waste Day Registration Information
Name
Mailing Address (if Different from Home Address):
Address
Address
City
State
Daytime Phone
City
Zip Code
State
Evening Phone
Zip Code
Cell Phone
Waste Materials
All household hazardous waste generated residentially will be accepted. This includes, but is not limited to, oil-based
paint, paint thinner, turpentine, varnish, pesticides, herbicides, antifreeze, used motor oil, fuels, household cleaners, mercury
products, poisons, batteries, aerosols, stains, polishes, and fluorescent light bulbs. In addition, electronic items limited to
computers, monitors and TV's, phones and fax machines will be accepted.
*PLEASE NOTE: LATEX PAINT IS NOT ACCEPTED
Pesticides, Herbicides, Acids, Bases, Solvents, etc (List Separately):
Type of Chemical/Description
Amount
Paint (Oil Based):
Total Gallons
Total Cans
Stains, Varnish, Coatings:
Total Gallons
Total Cans
Aerosol Paints:
Total Cans
Driveway Sealer:
Total Gallons
Total Cans
Mercury and Mercury Compounds:
Electronic Items: *Note:*We will only accept TV's, Computers, Computer
Monitors, Phones,Fax Machines From Households.
Type of Electronic Item
Amount
Total Volume
Flourescent Light Tubes:
Total Linear Feet
Batteries (Dry Cell-Household):
Total Number
Certification Statement
I certify that I am a resident of the Town of
Northumberland and that the waste listed on this form
is household generated and is not from any
institutional, commercial, or industrial facilities, or
commercial farming operations and does not contain
transformer oils, solvents, or other chemical products.
Signature
Attach additional sheets if necessary
Date
RESIDENTS:
*PLEASE NOTE*
THIS FORM WILL BE
MAILED TO YOU WITH
AN ARRIVAL TIME.
YOU MUST BRING THIS
FORM WITH YOU TO
THECOLLECTION SITE.
Assigned Arrival Time: