HomeMy WebLinkAboutREMOVAL PAPERWORK - 21-00778 - 227 S 3rd W - Demolition of 5 homesGreat Basin Services, Inc
P.O. Box 238
Blackfoot, Idaho 83221
Office: 208-785-1767
Cell: 208-681-6462
3-27-2020
RE: Asbestos Removal: House located at 261 South 3' West, Rexburg, Idaho
To Whom it may concern:
Great Basin Services has removed the Asbestos materials that were found to be present in
this building. The Asbestos materials that have been removed, were identified in the Asbestos
inspection report that was completed on this building. The Asbestos materials removed were the
sheet vinyl floorings located in the kitchen, upstairs bathroom, downstairs bathroom and
downstairs laundry room. These asbestos materials were removed by trained and certified
personnel using EPA approved removal methods. All asbestos materials removed have been
disposed of at an EPA approved landfill that accepts asbestos. A landfill manifest showing
proper disposal has been provided to the owner. The remaining building, as far as Asbestos is
concerned, may be demolished and disposed of as non -asbestos waste.
Dave Price, Owner,
Great Basin Services, Inc
UgEPA WASTE SHIPMENT RECORD FOR REGULATED ASBESTOS WASTE MATERIAL
R.Q. Hazardous Substance: Solid N.O.S. (asbestos): ORM-E NA-9188
GENERATOR
1
Work site name: qCA t (�
Location: 4h, 3— (At)el5f R,eK%JRy -rcL 8,3.ely D
0`?61 .
Mailing Address: 037— Re9.V1.04 t1jew &Z. Renbue3 sa 8-3y`fd
Owner's Name: v Owner's Phone: - 707,S Z
2
Operator's Name: Great Basin ervices, c. Contractor I.D. Number: C S/Z101Cq 11-36
Mailing Address: P.O. Box 238
Blackfoot, ID 83221
Contact Person: Dave Price Operator's Phone: 208-785-1767
3
Waste Disposal Site (WDS) DESTINATION:
Bannock County Landfill — a36-o6a�
Name: WDS Phone: o?O
1500 North Fort Hall Mine Road
Mailing Address:
Pocatello, ID 83201
Site Address/location: 1500 Fort Hall Mine Road
4
Name and
ddress of responsible agency (Local, District or EP Office where demolition/renovation notification was sent):
fit& eS
5Containers
Description of waste materials 7. Total Quantity
Number Type (Cubic Yards)
Ln
8
Special Handling Instructions and additional information:
9
OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper
shipping time and are classified, packed, marked and labeled, and are in all respects in prope ondmon r ansp n by highway according to applicable
international and government regulations. (Obtain signature in Item 10 before taking Gold s eel for receip .)
Dave Price Owner
_
Printed/typed Name Title Sign (mtamnn•vl
TRANSPORTER
10
Transporter 1 (Acknowledgement of receipt of materials)
Name: Great Basin Services, Inc. Phone: 20 5-1767
Address: P.O. Box 238
Blackfoot, ID 83221 j
PtinteNtyped Name Dave Price Title _- Owner sigmd e Date (mmiDD/m
11
Transporter 2 (Acknowledgement of receipt of materials)
Name: Phone:
n
Address: 1l/
Printed/typed Name Tide Signature Date (enwnonv)
WASTE DISPOSAL STTE
12
Discrepancy indication space:
13
WASTE DISPOSAL SITE CERTIFICATION: I hereby certify that the above named material has been accepted and to the best of my knowledge
the foregoing is true, accurate and complete except as noted in Item 12.
pfe4k4.r _ Gl� 3 z , 2-0
Pnnted/type Name Title Signature Date (mwnorvv)
Upon transfer: Owner/operator retains GOLD, Transporter retains PINK, WDS retains YELLOW and sends completed VVHM copy to operator in item 2.
M Wenn Nnnng. Inc. • fuuUmt. m 83221. (M)7g 051]
D&D ENVIRONMENTAL CONSULTING, INC.
CERTIFICATE OF TRAINING
This is to Certify That
BOBBLE CI3AVEZ
2956
Has Successfully Completed an EPA/AHERA Asbestos Refresher Training Class
Under Section 206 of the Toxic Substance Control Act, Title II.
In:
CONTRACTOR/SUPERVISOR
Course Dates: December 9, 2019
No. of Hours: 8
Certificate No:CSR120919-37
Expires: December 9.2020
Douglas A. Aldinger, Director of Training
D&D Environmental Consulting, Inc.
7345 South Pierce Street, Suite 104
Littleton, CO 80128
(303) 870-1032
D&D ENVIRONMENTAL CONSULTING, INC.
CERTIFICATE OF TRAINING
This is to Certify That
CHRIS EARLY
6040
Has Successfully Completed an EPAIAHERA Asbestos Refresher Training Class
Under Section 206 of the Toxic Substance Control Act, Title II.
CONTRACTOR/SUPERVISOR
Course Dates: December 9, 2019
No. of Hours: 8
Certificate No:CSR120919-38
Expires: December 9, 2020
Douglas A. Aldinger, D ector of Training
D&D Environmental Consulting, Inc.
7345 South Pierce Street, Suite 104
Littleton, CO 80128
(303) 870-1032