removal record SF,RVICE TRANSPORT GROUP, INC.
58 PYLES LANE, NEW CASTLE, DE 19720 PHONE: (877)999-9559
N°. 5068631 WASTE SHIPMENT RECORD Dt-Wt--OD j, -- ZJ,:a \c\
S.T.G.#
1. Material Origin Site Generator: Name/Address Ntinct G nerator: Phone #
ac. Sam. t•1 , A tk kaa 5v- ,(53c -exs die ct
Q rs\04x. ,* t as h ct Cocio, Rd .
e. b \1 to65I ,
2. Removal Contractor: ame/Address (jl,'tt ' � aiG�' n Q Contractor: Phone #
t on DES, Luc:..:
C4` tr\& to-f 0 Contact: iYt L u i .. LVi. •SI c)-3
3. Responsible Agency: Name/Address 4. US DOT Class - FRIABLE ASBESTOS ONLY
U 5 cPA t rc��c"Afit..
x act c �r..� El.; NA2212, Asbestos, 9, PG III, RQ
0 `�`,C -�' {i i . tC-Cf f< 5. Description of Materials Containers Total Quantity (yd3)
CC W Specify Friable or Non-Friable No. Type
WIF Friable(enter required information) 4 154; ' 't"t
C\F
IF Non-Friable(check one):E Category I n Category II
6. Special Handling Instructions 24-hour emergency spill response no. 800-424-9300
7.Generator Certification:
This is to certify that the above named materials are properly classified,described,packaged, marked and labeled and are in proper condition for transport by highway
according to the applicable regulations of the Department of Transportation,US ERA_and any other state government agency.I certify that the foregoing is true and correct
to the best of my knowledge.It the waste shipment is not as I stated,I accept the RETURN of the COMPLETE LOAD to the generator's service location at the generator's
expense.
Printed/Typed Name &Title `� Signatur Date C�`
ANN CAR; CVO.CVO. `cc�tk�a SYVAC.. - rci Art a -6 - I
8.Transporter 1 (Acknowledgement of Receipt of Materials) , see Transporter 2 or 3 below.
Company Name & Address Signature:)1,,..a.,,eit , d.) Telephone No.
cc lCT) 0 E..5 , LL S l(3-.)5t. 1. 5D
Fe 0 Se_t11 \-Cs-0 c. Printed Name: .._\r� .0t\l_o qA c'� Date:
l 1 1t:4 � -0S- Title: f,.- 1-
d9.Transporter(Acknowledgement of Receipt of Materials) If Transporter 1 &2 are blank,Transporter 3 servers as sole transporter.
Z Z Company Name & Address Signature:
Telephone No.
Q
NPrinted Name: Date:
Title:
10.Transporter 3(Acknowledgement of Receipt of Materials)
Company Name& Address Signature: Telephone No.
Service Transport Group, Inc. 877-999-9559
Lit Pyles Lane Printed Name: Date:
N. New Castle, DE 19720
Title:
M 11. Discrepancy Indication Space:
H12. Waste Disposal Site Owner or Operator's Certification (Receipt of above Waste except as noted in 11)
09 Waste Disposal Site (Check One) STG USE ONLY Date:
Signature:
HAlliance Landfill Minerva Landfill —
0 398 S.Keyser Ave. 8955 Minerva Rd. Printed Name:
® Taylor, PA 1 851 7-1 009 Waynesburg,OH 44688
570-562-1600 330-866-3435
Permit No. 100933 Permit No. P0104984 Title:
WHITE-Generator•GREEN-S.TG.•YEL LOW-Contractor•PINK-Landfili•GOLD•Pidc Up Receipt
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40a*rsmr Green Ridge Landfill Original
424 Peters Rd Tirket# 29088
Gansevnort, NY, 12831
Ph: (518) 636-2141
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,mer Name CASELLADlRECTHAUL CASELLA' WAS Car}Ner CAS CASELLA WASTE
et Date 02/20/2019 Vehip-le# 4090 Volump
ment Type Credit Account Container
oual Ticket# ' Dr/vpr
�
aulinQ Ticket0 .~ ~Check#
Joute Billing # 000014�
State Waste Code Gen EPA ID
Manifest
Destination G'id D 28 LIFT 3
Profile (>
Generator
Time Scalp Ope rat ur Inbound Gros 54940 lb
In 02/20/8019 14z Inbound SD #605115 Tare 3644N lb
Out 02/20/2019 14: Outbound SD #605115 Net 18500 lb
Tony 9.25cc
_
U U "'"'^ ' - -'
w ° |
--OWN OF-0)'JEENSEURY
BUILDING
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AGEMENT
Sreen Ridge Landfill Original
4-24 Peters Rd
Ticket# 2891E
Oanriovoort, NY, f283l
Ph: i,510) 636-;Ii4i
.,A- ,,Q‘ Name CASELLADIRECTHAOL CASELLA WAS Carrier CAS CASELLA WASTE
18/209 Vehicle# 4399 Volume
lypc- uredit ALc-ounl.
Container
• ;,, -,,,...: ' 7.1,07, :' Drivet•
IP' , , . ..] “.:i:ef. Cherk#
7 .,-,,:
illing V 0000141
'',, . „,,, ir,'-t-i, , o,.;,;• 6en EPA) ID
Srtd D 28 LIFT
. „-
:-.:;, le Operator Inbound Gross 54900 lb
inhalnd SD #605115 Tare 39580 lb
rl.Vii''' i,7:: OW;z)vu[ir 5 l's• 4*6051 I 5 Net 15320 lb
To nli 7.66 OPD
LIVE LOAD JOB - DEMOLITION -
ON LEFT JUST AFTER COLUMBIA AVE
Printed by: SLAFRANCE on: 2/13/19 at : 11 : 07 I/A
Priority:
.._...,-.......------ ,
rPI, MAR 05 a 3 U
TOWN OF OTELN,:',L,7-7. ,
BUILDING, ,,S.,:.:!,.•1 ,, ,__
Green dge Landfili Origin�l
424 Peter� Rd Tickett 2893L�
Gam�avoor�, NY, �283�
Ph: i518) 636-2141
to
r Wame CA�ELLADIQECTHAUL CA8ELLA WAS Carrier CAS CASELLD WASTE
02/18/2019 Vehjcle#
eent Type Credit Account Cot -ainer
Manual Tickpt# Do,ivpr
Hauling Tic�et# (:heck#
/
Route
Billing # 0kOk8141
State waste Code Gen EPIA ID
Manifest
Deotinatinx Grid D 26 LIFT 3
Profile (>
Generatmr
TI Me Scale Operator Gross 55900 1b
In 02/18/2019 15: Inbound SD #605115 Tare 39N6W lb
'Dw 02/16/20l9 15; Gutboond SD #605|15 Net /6840 lb
- '- - - T»na G^42CO
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to
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/
EMENT
Oreen nido . Landfill Origin.?
424 Peters Rd Ticket# 26901
Gan,•:evoor°t, NY. '12831
Ph: :518 i 636--2 41
tower Name CASELLADIRECTHAUL. CASELLA WAS Carrier CAS CASELLA WASTE •
cket Date 0 /16/2.011 Vehicle# 4369 ijGiu e
a,event Type Credit Account Container
'-Mvnual Ticket# Driver
Hauling Ticket# Checl #
pnute Billing # 0000141
State Waste Cade Gen EPA ID
Manifest
Destination Grid D 28 LIFT 3
Profile 9
Generator
Time Scale Operator- Inbound Groan 4604E lb
in r 18/ 019 11: inbound SD #605115 Tare 38040 lb
1)l_rt. 02;18/2019 11: Outbound Si) #6' 5115 Net 10000 lb
5.00 Or
LIVE LOAD JOB - DEMOLITION -
ON LEFT JUST AFTER COLUMBIA AVE
ZONE 3
Printed by: KJOHNSON on: 2/18/19 at : 14 : 46 I/A
Priority:
per—`
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