Paul "Puppy" Simmons is the Racket Boss of the garbage racket in Barclay Mills, running it for Enzo Conti. Paul earned the nickname "Puppy" because ladies thought he was so cute way back when. Now he's a sadistic bastard who'll do anything for a buck. 
While handling the garbage in a city the size of New Bordeaux is profitable enough, the real money comes from Puppy's side operations: extortion, disposing of hazardous waste, and "cleaning up" dead bodies.
Anyone who handles garbage in the city pays up to Puppy. All the industry generating hazardous waste in the city pay Puppy a premium for its disposal; that waste is then dumped into the river while Puppy pockets the cash. An operation the size of Marcano's produces a steady flow of dead bodies, which Puppy's cleaners take care of for a price.
In 1968, Simmons' racket was taken over by Lincoln Clay, who was working with inside information he received from Maria Bava. Lincoln damaged Puppy's garbage operations by blowing up his equipment, killing his cleaners, and sinking the racket's garbage barges. Once everything fell apart, Simmons resurfaced, giving Lincoln the opportunity to confront him. After successfully infiltrating Di Napoli Waste Removal, Lincoln dealt with Simmons and ended his association with the Marcano Crime Family.