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HomeMy WebLinkAboutLetter (asbestos disposal) - 12/20/2001 VALLEY TRAIL RECYCLING AND DISPOSAL FACILITY A WASTE MANAGEMENT COMPANY P.O. Box 286 N9101 Willard Road Berlin, Wisconsin 54923 (920)361-4995 (920)361-1682 Fax November 14, 2001 City of Oshkosh 215 Church Ave. Oshkosh, WI 54903 Re: Asbestos Disposal ASB # 19865 To whom it may concern: Enclosed please find a copy of the Waste Shipment Record for the load of Asbestos brought to the landfill from your facility. This form is being mailed to you in accordance with state regulations. Please keep it for your records. Thank you for your cooperation in this matter. if you have any questions, please call me at (920) 361-4995. Sincerely, Valley Trail Recycling and Disposal Facility A Division of Waste Management of Wisconsin, Inc. ~' assn C. Buchholz Special Waste Coordinator Enclosures A Division of Waste Management of Wisconsin, Inc. . .- .. __ .. NON»FR°Y~BLE ~ ;. ~ 4 . . 2109132 VI~A~'TE SHIPIIAEWT RECORD /A.~'8~'.$TOS 'MANI~EST For Disposal sits use vny (See Reverse for Instrudans) '- ,. 1-A.SpeGal Waste :Profile Number NI=SNAP Notifled W Number Elevation Mwo? 8865 YES x NO ~~~~~, : m .. Nor >~ast ~1-B. GanaratorName, Contact Name, and Coinptete Mailing Address (ificluding Zp Code) ~ "City of Oshkosh ;. 1-C: C~enerator's'Ptroria Number ; ~~.:21~5 -Chura~h Av®naa 920-236-5055• Ol~hkosh, WI 54903 i-b. Wbtk-9ite Addrese ~@sic3rsntisls 1-E. 24 Hour Emergency f~e6ponse Telephone Number 23133 J ffarsq~z~ gtr~gt $ ,~-~ -I~..~lan Olahkos~i WI 5! 9'01. 9Z0-688-26Q8" 2.Operator's Name and Complete Mailing Address ' ~'~.~AT LoCk ~° htlf.~ r Operator's Phone Number ' 11 ~1 E CQUn~ ItQad ~ . • Os ,kosfi WY ~90Z 924-688-26E18 ~ . 3: Waste Disposal Site (WDS) Name and Complete Maiing Address WDS-Phone Number Vauey Trail Recycling & DispDSai Facility 820/361-4995 -N~tOtWillardR . ~ ::0, BQX 256; Wallin, WL~A923 _ _,, 4. Name and Address of Respons'ble Agency Mate. t>f ~Wisccutsin; Degartmenf of IValu[al Resources Bureau of Air Pollution; R. O. Box 10445; f3rt~an gay, WI 54307 ~ 6, Description of Materials . . . 6. Containers 7. Total Quantity ~ „.. _ - . F. < . ., No: s Type Yd~ ", .: 'friable 9sbg$tos - 1~sbestos, 9,"NA$21~; i0; ffq 'npn-friable asltestos Cat I 'Cat ~~LlN O ~G~.1E' /~ ~. ~ ~~, 8. Special Hanctling)ngtructions and Additional Information: 24 HQUR NElTICE; MUST BE $11R1ED , , ,9. GEsNEF3ATOR/OPERATOR'S CERTIFICATION: I fiereby declare that the contents bf this aoiisignment are fully and accurately desCrlbed atSOVe by proper ship- p>Ing Hama and are classif-ed; packed, marked, artd labeled, and are in all respects in proper condi9on for transport by highway according to app8cable intematlonat 'and gbvgmnient'regufaiwhs: Thereby certry that'tfie asbdsfos'is not:oorttaminatetiwi~h ~Mdus, PEW; anctlor "any Special waste ` .: PrkttedR'yped Name and Title' SigtiatUre - r bate 1f). transporter 1 Company Name Driv ,g ture of ~ " Fib®s Lock,, Inc, - , ,, . ..Complete Mailing Address' • 1151 E. County Road Z Oshkosh, WI 54902 . - .: Printed Namg end Tale • Telephor~ Number (including area cone) :9Zfl--688-2608 o ats ~ i .Transporter 2 Company Name ` Wastes Mariag~me,int 'Driver Signature , ~ ` Complete Mailing Address a2a4 Csc~oks A~®. , Kaukauna, WI 54130 PrintedNameandTitle ' ' 7elephoite Number (inducting:area code) / f~l,~j/' /~,,,~ _... j ~~r" _ 32b--?39;-'7Y31 , . ate ' `12. Discrepancy IridiGation Space , rA ` r1~ Was#®.DiaposarSPt6Ow~er.orOpbrator , , Specr$I 1~Vaste Approval is issued by:signature in.the case of a Generic Asbestos Approval. ` Certificatlon of receipt of asbestos materials covered by~mis mangiest except as Holed In Item 12. `nted(Fyped Name-and TRIe ~ lure pate - 1/ E ., tlVFIITE -' Dispoeal Site CANAFlY -Generator PINK - T 1~CE-230-97•VT (To be mailed by Daposel Site) rer~~gpPr GOLD (To be aerator en prior to disposal) -.w.:r•n V, :,r• ` . ~ I U . ~~" `~... , .: t~ F' , ~' Y ~ I i • r `^"'+ i~ ' g' ~ ~ r 1'" ,~ i ~ A a-tM'.. . A a.. ' r+~ ..av` - 1 A~ T-~+'4" i ~ ~ ~ ~~ 77~~ LL~~ }} y + ~ / ~ ry ~~ ~'pl C~aA~~T.~ - + 21 (3 ~-~ ~lr . ~ ~~ .. .WASTE SHIPMENT RECQRD/I~~fibi~ M~t~tlR~ST ~ ~~ disposal Bite use onry ( Revera~ for Inatructtone) k t-A.Special Waste Profile NunfYer 3HAP Notified 1w , Etevatlon ~"~ ' ' - ` 1c ~ MGIta1986!!'` r. ` YES X" NO ~~~W>(iJ Norl~~~East~-~~.~` • t- '. Generzltor Name, Contact Narne,'and e A mckrding 2tp } City of ©shkvsiE<h ~ ~ 1-C. Generator's phone Number ? .. ~1 ~ Church A~et~~e ~ ' ..... oshkoah, WZ 5~9~3 920-23.6-5455 1-D. VYa[k SitA Adidreps` . ,' , - t-~: 241iour;~nerpel~cy kle!sponse` Telephone Number ash WI 54941 ~ ~ 920-6&8-208 2. Operator's Name and Complete MaiNng Address F`' f,~, r Lock„ xAC. Operator's Phone Numbe[ .11 ~1 E County Evad Z - Oshkosh WI 5.4902 9Zf1-688-26Q8 3. Waetie Disposal Site (WOS) NamA arW Complete AAeYkig Address + WDS'Phone Nixnber Its . T ;'I -Recyclut _ D' aGii' ~~~ _ +" ~~f l~artll~oad; p.::a..8ox . 9er~nr W~ 54923, 92 /361-4995 4. Name and Addross of ReBpOnsllNe Agency ate of VWsaarisin;•~Dep>3rfhrtprtf t# Niatur'ai Reapcacea Bureau of Air PoAution; p. O. Box 10!148; Green Bay, WI 54307 b. Description of Materials f 6. Containers 7. Totai c uardigr Asbeetce, 3„ N4~t2, Tit, RQ .,- 7 ` nor~frieple asbestos • ' Cat I ~ Cat ~~ $• Special Handlir~, I~ and Additional infomration - ~; ~ ; ; 24 ~tOtlti' NOTICE, MUST Bff ~UR1E0. :: : - `,t 9. GENERATORlOFEIiAT~R'S CERTIFICATION: ) hereby declare that the contetrts of this oonsignmerit-are fully and accxuately described above by proper ship- m ~ .:prop na e and are daseiNerl, peolcsd, meAad, and leitlNsd, and are in a1 respects m proper condition for Transport by highway according to applicable. irrtematiortaf `at-d 9~-n ~s:'4 hereby ~y'thet-the esbAirrbs b not oorgamhlate0 wftti ttaxardous, fsG6, andJar arty speaal waste. '''' prlnt9d~yped'htame grid Title ~ Date ~u < o . _ ~ ` 1U: Trar~poRer i Cpmpany Name Orlver re ,, ~:lber Lock,' Inc. ;,; ~` Complete fiAailing l4ddrese ,, - _ . t 151 E County Road Z . ' ~~ /~1,,~-~l ~` Irv 1- ! e r~ t_~ , 4 Oshkosh, WI 54902 ; _ , ~ '~".~ - ,k, _ _ ---,. ,~l- .. ... ' e ~ ~'i nnt~~an19-T._ T~1~..1 ~ ~ - . . Telephone Numben(irtoluding area code) . ~. j. t ' t r 7 r-) S ~; ~ / ! V (! ( S./ 92~-F8$--2608 Date : 11. Transporter 2`Corrrpany Name , : Driver Signature. +. Waste Management . complete htani~g address 22Q4 crooks Ave. Kaukauna, WI 5~"f3© Printed Name and Tit Te-ePnone lVtfmber (irx~ing area ogde) ~ ~ : y2. D trxOca~6ori"Space , ~ - ~ 1 ~. Wastq ©ispoeal -Site Orw1e'ror ~per~• SpeClal Waste Approval is issued by signature in the case of a Generic Asbestos Approval 6ertilfcation of fei~ipt of asbestos: materials twvered by this marifiedt except as noted In lJen1 t2. p . Pri yped Name and Ti Signature Date ..,: ' 1NHITE - t)itfpoeal SI6a I.AN/~FiV - t3enaratar PINK - Tranaportec GOLD - for DCE-230.87-vT (To be: rrwded Dy t)leppsld Sqe) (To be taken prior to disposal)