"Part 360 Series Waste Tracking Document - Construction & Demolition Debris" - New York

Part 360 Series Waste Tracking Document - Construction & Demolition Debris is a legal document that was released by the New York State Department of Environmental Conservation - a government authority operating within New York.

Form Details:

  • Released on May 1, 2018;
  • The latest edition currently provided by the New York State Department of Environmental Conservation;
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Part 360 Series Waste Tracking Document - Construction & Demolition Debris
This form may be used to satisfy the tracking document requirements of
both section 361-5.6 and section 364-5.1 for the transport of C&D Debris
□ Limited-Use Fill □ Restricted-Use Fill □ Contaminated Fill □ Fill Material - Unknown
TYPE OF C&D
□ General Fill
Residue
Construction Waste
Demolition Waste
DEBRIS:
□ Other (specify): ________________________________________________________________
WASTE QUANTITY:
___________ Tons
__________ Cubic Yards
Check box to indicate quantity is estimated: □
Source Name: ___________________________________________________________________
LOCATION WHERE
Address: _______________________________________________________________________
WASTE WAS PICKED
UP:
City: _________________________________ State: __________ Zip Code: ________________
GENERATOR: Name: ______________________________ DEC Permit/Reg. No. (if applicable): _____________________
Address: ______________________________________ City: ___________________ State: _____ Zip: _____________
Authorized Representative of Generator: __________________________________ Phone: _______________________
Transporter Name: ___________________________________________________________________________________
Chosen by Transporter
Receiving Facility Name: _______________________________________________________
Address: _____________________________________ City: _____________________ State: _____ Zip: _____________
I have completed this tracking document describing the waste and identifying the transporter and receiving facility. I certify, under penalty of law, that the information
provided in this waste tracking document has been prepared under my direction and supervision and further certify that the information contained herein is true and
accurate. I am aware that any false statement made on this document is punishable pursuant to Section 210.45 of the Penal Law.
Signature:
Date
________________________________________________________
___________________________
:
TRANSPORTER: To be completed by Transporter
DEC Permit/Registration No.: ___________________
Transporter Company Name: __________________________________________________________________________
Describe all Discrepancies in type or quantity of waste: ______________________________________________________
___________________________________________________________________________________________________
Driver Name (print):
Phone:
Plate No.: _
_____________________________________
______________
_________
Signature:
Date:
___________________________________________________________
________________________
RECEIVING FACILITY: To be completed by Receiving site
DEC Permit/Reg. No. (if applicable): ____________________
Name: ________________________________________ Address: _____________________________________________
City: _______________________ State: _____ Zip: ____________
Put [X] for: [ ] interim processor, or [ ] final site
Describe all Discrepancies in type or quantity of waste: _______________________________________________________
__________________________________________________________________________________________________________________________________________
I certify, under penalty of law, that the information contained herein is true and accurate.
I am aware that any false statement made on this document is punishable pursuant to Section 210.45 of the Penal Law.
Print Name: ____________________________________________________ Phone: ______________________________
Signature: ______________________________________________________ Date: _______________________________
The completed tracking document for all waste types must be returned to the Generator within two weeks of receipt of the waste.
Statewide for restricted-use fill, limited-use fill and contaminated fill, and for all waste types, except residue, generated in the City of New York,
a copy of the completed tracking document must also be provided to NYS DEC within 15 days of waste delivery to the receiving facility.
[ref: 6 NYCRR 364-5.1(b)(5)]
Return completed forms to NYS DEC by e-mail to transport@dec.ny.gov OR fax to 518-402-9034
Rev: May2018, Ver 1
OR mail to 625 Broadway, 9th Floor, Albany, NY 12233-7251.
Part 360 Series Waste Tracking Document - Construction & Demolition Debris
This form may be used to satisfy the tracking document requirements of
both section 361-5.6 and section 364-5.1 for the transport of C&D Debris
□ Limited-Use Fill □ Restricted-Use Fill □ Contaminated Fill □ Fill Material - Unknown
TYPE OF C&D
□ General Fill
Residue
Construction Waste
Demolition Waste
DEBRIS:
□ Other (specify): ________________________________________________________________
WASTE QUANTITY:
___________ Tons
__________ Cubic Yards
Check box to indicate quantity is estimated: □
Source Name: ___________________________________________________________________
LOCATION WHERE
Address: _______________________________________________________________________
WASTE WAS PICKED
UP:
City: _________________________________ State: __________ Zip Code: ________________
GENERATOR: Name: ______________________________ DEC Permit/Reg. No. (if applicable): _____________________
Address: ______________________________________ City: ___________________ State: _____ Zip: _____________
Authorized Representative of Generator: __________________________________ Phone: _______________________
Transporter Name: ___________________________________________________________________________________
Chosen by Transporter
Receiving Facility Name: _______________________________________________________
Address: _____________________________________ City: _____________________ State: _____ Zip: _____________
I have completed this tracking document describing the waste and identifying the transporter and receiving facility. I certify, under penalty of law, that the information
provided in this waste tracking document has been prepared under my direction and supervision and further certify that the information contained herein is true and
accurate. I am aware that any false statement made on this document is punishable pursuant to Section 210.45 of the Penal Law.
Signature:
Date
________________________________________________________
___________________________
:
TRANSPORTER: To be completed by Transporter
DEC Permit/Registration No.: ___________________
Transporter Company Name: __________________________________________________________________________
Describe all Discrepancies in type or quantity of waste: ______________________________________________________
___________________________________________________________________________________________________
Driver Name (print):
Phone:
Plate No.: _
_____________________________________
______________
_________
Signature:
Date:
___________________________________________________________
________________________
RECEIVING FACILITY: To be completed by Receiving site
DEC Permit/Reg. No. (if applicable): ____________________
Name: ________________________________________ Address: _____________________________________________
City: _______________________ State: _____ Zip: ____________
Put [X] for: [ ] interim processor, or [ ] final site
Describe all Discrepancies in type or quantity of waste: _______________________________________________________
__________________________________________________________________________________________________________________________________________
I certify, under penalty of law, that the information contained herein is true and accurate.
I am aware that any false statement made on this document is punishable pursuant to Section 210.45 of the Penal Law.
Print Name: ____________________________________________________ Phone: ______________________________
Signature: ______________________________________________________ Date: _______________________________
The completed tracking document for all waste types must be returned to the Generator within two weeks of receipt of the waste.
Statewide for restricted-use fill, limited-use fill and contaminated fill, and for all waste types, except residue, generated in the City of New York,
a copy of the completed tracking document must also be provided to NYS DEC within 15 days of waste delivery to the receiving facility.
[ref: 6 NYCRR 364-5.1(b)(5)]
Return completed forms to NYS DEC by e-mail to transport@dec.ny.gov OR fax to 518-402-9034
Rev: May2018, Ver 1
OR mail to 625 Broadway, 9th Floor, Albany, NY 12233-7251.