TAB 3 Concrete and Construction Debris Disposal Form.doc

PROJECT NAME

SECTION 01030

EIELSON AFB, ALASKA

SAFETY, ENVIRONMENTAL PROTECTION,

FTQW XX-XXXX

REGULATIONS, AND CODES

(Appendix F)

CONCRETE AND CONSTRUCTION DEBRIS DISPOSAL (C&D) CHECKLIST

at the

QUARRY HILL LANDFILL AND FLIGHLTLINE POND

Eielson AFB, Alaska

PROJECT:

DATE OF PLACEMENT:

POC:

______________________________ CONTACT NUMBER

AMOUNT OF WASTE TO BE DISPOSED OF: ____________________ Cubic Yards (CY) Disposed of at: Quarry Hill FORMCHECKBOX Flightline Swamp FORMCHECKBOX

1.

Is there paint on the waste material?

FORMCHECKBOX

Yes

FORMCHECKBOX

No If yes, has paint been tested for Lead Based Paint (LBP)?

FORMCHECKBOX

Yes (results must be attached)

FORMCHECKBOX

No If yes and it is LBP, has a TCLP been done?

FORMCHECKBOX

Yes (results must be attached)

FORMCHECKBOX

No

NOTES:

2.

Is there Asbestos-containing Material (ACM) in with the waste?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

If yes, the ACM needs to be separated If segregation of the ACM is not feasible, the entire load needs to be placed in Eielson’s ACM Landfill (call CES Insulation Shop at 377-1577)

OR

Disposal of the load at another facility, permitted by the State of Alaska, such as the Fairbanks North Star Borough Landfill.

NOTES:

3. Is there Petroleum Contamination, or Petroleum-based Material in the waste?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

If yes, does it have “free liquid” that easily falls off of the waste material?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

If yes, this waste material CANNOT be placed in the Quarry Hill C&D Landfill.

If the waste material is just stained, it may be placed in the Quarry Hill C&D Landfill.

FAX BY FRIDAY EACH WEEK TO 377-3367 POC NANCY POWLEY

NOTES

01030, Appendix F