Applicants Name :

Date :

Address :

City :
 State : Zip :

Telephone :

Email :

Date Truck Needed :

Date Truck Picked Up :

Truck Number :

The following items require separation before disposal at the Smyth County Transfer Station:
1. Tires
2. Metal or White Goods (Refrigerators, Stoves, Etc.)
3. Brush, Tree Limbs, or Yard Waste

The following items may not be disposed of at the Smyth County Transfer Station:
1. Hazardous or Special Waste, as defined by Virginia Solid Waste Regulations
2. Sludges or Free Liquids
3. Paint, Stains, Etc.
4. Motors, Transmissions, or any oily parts

You are agreeing to the enclosed conditions concerning the separation of disposed material and you agree with these conditions. If materials are found in the truck that do not comply with the conditions that are set forth, then the applicant will be charged for the disposal of the materials.

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