Bureau of Waste Management Revised 12-14-15 Supplemental Waste Tracking Form Instructions: When any load of waste is rejected for disposal at your facility, please complete the following supplemental waste tracking form and send it electronically to the Department’s Municipal and Residual Waste Division by using ra-epmuniresidwaste@pa.gov with “SWTF” in the subject line. Please copy your Regional DEP office as well as the waste generator on the electronic transmission. Form: Landfill Name: KEYSTONE SANITARY LANDFILL Date Waste Rejected: 01/06/2016 Generator Name: SOUTHWESTERN ENERGY Generator Address: PO BOX 789 Conway AR, 72033 Generator Contact Person and Phone Number: MARNE GREENLEY 570-996-4219 Generating Location (i.e. Site or Well #): ROBINSON WEST 1-7H County of Origin: Susquehanna Waste Code: Tonnage: Box Name/#: Meshoppen Stone Bill 570-4990139 GAGE Trucking was hauler EC#: Township of Origin: External Gamma Radiation Levels – Center line, Midpoint Dose Rate (µR/Hr): Right Side: N/A Left Side: N/A Current Waste Status/Location: Returned to Generator Temporarily Stored at Landfill Sent to Alternate Disposal Facility Reason for Rejection (continued on next page…) Name of Facility (if known) Revised 12-14-15 Reason for Rejection – (please make a selection by checking the checkbox next to the reason for why a waste load was rejected): 1. ☐ Business decision: Operator chooses not to accept waste 14. ☐ Not in county plan or out of county 15. ☐ Profile tonnage limit reached 2. ☐ Driver does not have required personal protective equipment 16. ☐ Shipping log incomplete or improperly completed 3. ☐ Driver went to wrong landfill 17. ☐ Tailgate jammed 4. ☐ Expired Form U 5. ☐ Expired profile 18. ☐ TENORM dose rate (µR/hr) exceeds limit in permit conditions 6. ☐ Form U tonnage limit reached 19. ☐ Unloading mechanism failed 7. ☐ Generator unable to pay for disposal 20. ☐ Vehicle is not equipped with required safety equipment 8. ☐ Invalid Form U/EC number 21. ☐ Waste disposal not scheduled 9. ☐ Invalid profile number 22. ☒ Waste is not approved for disposal 10. ☐ Monthly Source Term Allocation limit reached 23. ☐ Waste is not included on shipping log 11. ☐ No Act 90 sticker 24. ☐ Waste is not properly categorized 12. ☐ No DEP cab card 25. ☐ Waste is not solidified 13. ☐ No vehicle registration 26. ☐ Waste is yard waste, brush, asbestos, etc. 27. ☐ Other (please provide an explanation): This load was rejected because the waste was from Robinson West Pad that is not approved waste, and once again this driver also tried to provide incorrect paperwork indicating the load was from Howland -Lent Pad. Bureau of Waste Management Revised 12-14-15 Supplemental Waste Tracking Form Instructions: When any load of waste is rejected for disposal at your facility, please complete the following supplemental waste tracking form and send it electronically to the Department’s Municipal and Residual Waste Division by using ra-epmuniresidwaste@pa.gov with “SWTF” in the subject line. Please copy your Regional DEP office as well as the waste generator on the electronic transmission. Form: Landfill Name: KEYSTONE SANITARY LANDFILL Date Waste Rejected: 01/06/2016 Generator Name: SOUTHWESTERN ENERGY Generator Address: PO BOX 789 Conway AR, 72033 Generator Contact Person and Phone Number: MARNE GREENLEY 570-996-4219 Generating Location (i.e. Site or Well #): ROBINSON WEST 1-7H County of Origin: Susquehanna Waste Code: Tonnage: Box Name/#: Meshoppen Stone TA7 Bill 570499-0139 EC#: Township of Origin: External Gamma Radiation Levels – Center line, Midpoint Dose Rate (µR/Hr): Right Side: N/A Left Side: N/A Current Waste Status/Location: Returned to Generator Temporarily Stored at Landfill Sent to Alternate Disposal Facility Reason for Rejection (continued on next page…) Name of Facility (if known) Revised 12-14-15 Reason for Rejection – (please make a selection by checking the checkbox next to the reason for why a waste load was rejected): 1. ☐ Business decision: Operator chooses not to accept waste 14. ☐ Not in county plan or out of county 15. ☐ Profile tonnage limit reached 2. ☐ Driver does not have required personal protective equipment 16. ☐ Shipping log incomplete or improperly completed 3. ☐ Driver went to wrong landfill 17. ☐ Tailgate jammed 4. ☐ Expired Form U 5. ☐ Expired profile 18. ☐ TENORM dose rate (µR/hr) exceeds limit in permit conditions 6. ☐ Form U tonnage limit reached 19. ☐ Unloading mechanism failed 7. ☐ Generator unable to pay for disposal 20. ☐ Vehicle is not equipped with required safety equipment 8. ☐ Invalid Form U/EC number 21. ☐ Waste disposal not scheduled 9. ☐ Invalid profile number 22. ☒ Waste is not approved for disposal 10. ☐ Monthly Source Term Allocation limit reached 23. ☐ Waste is not included on shipping log 11. ☐ No Act 90 sticker 24. ☐ Waste is not properly categorized 12. ☐ No DEP cab card 25. ☐ Waste is not solidified 13. ☐ No vehicle registration 26. ☐ Waste is yard waste, brush, asbestos, etc. 27. ☐ Other (please provide an explanation): Truck came back in 10 min later with same Robinson West Pad waste but driver tried to provide manifest for Howland-Lent Pad. Load rejected due to Robinson West not being approved and driver providing incorrect paperwork for the load. The hauling company that provided false information was Meshoppen Stone, phone number above. Revised 12-14-15 Bureau of Waste Management Revised 12-14-15 Supplemental Waste Tracking Form Instructions: When any load of waste is rejected for disposal at your facility, please complete the following supplemental waste tracking form and send it electronically to the Department’s Municipal and Residual Waste Division by using ra-epmuniresidwaste@pa.gov with “SWTF” in the subject line. Please copy your Regional DEP office as well as the waste generator on the electronic transmission. Form: Landfill Name: KEYSTONE SANITARY LANDFILL Date Waste Rejected: 01/06/2016 Generator Name: SOUTHWESTERN ENERGY Generator Address: PO BOX 789 Conway AR, 72033 Generator Contact Person and Phone Number: MARNE GREENLEY 570-996-4219 Generating Location (i.e. Site or Well #): ROBINSON WEST 1-7H County of Origin: Susquehanna Waste Code: Tonnage: Box Name/#: Meshoppen Stone TA7 Bill 570499-0139 EC#: Township of Origin: External Gamma Radiation Levels – Center line, Midpoint Dose Rate (µR/Hr): Right Side: N/A Left Side: N/A Current Waste Status/Location: Returned to Generator Temporarily Stored at Landfill Sent to Alternate Disposal Facility Reason for Rejection (continued on next page…) Name of Facility (if known) Revised 12-14-15 Reason for Rejection – (please make a selection by checking the checkbox next to the reason for why a waste load was rejected): 1. ☐ Business decision: Operator chooses not to accept waste 14. ☐ Not in county plan or out of county 15. ☐ Profile tonnage limit reached 2. ☐ Driver does not have required personal protective equipment 16. ☐ Shipping log incomplete or improperly completed 3. ☐ Driver went to wrong landfill 17. ☐ Tailgate jammed 4. ☐ Expired Form U 5. ☐ Expired profile 18. ☐ TENORM dose rate (µR/hr) exceeds limit in permit conditions 6. ☐ Form U tonnage limit reached 19. ☐ Unloading mechanism failed 7. ☐ Generator unable to pay for disposal 20. ☐ Vehicle is not equipped with required safety equipment 8. ☐ Invalid Form U/EC number 21. ☐ Waste disposal not scheduled 9. ☐ Invalid profile number 22. ☒ Waste is not approved for disposal 10. ☐ Monthly Source Term Allocation limit reached 23. ☐ Waste is not included on shipping log 11. ☐ No Act 90 sticker 24. ☐ Waste is not properly categorized 12. ☐ No DEP cab card 25. ☐ Waste is not solidified 13. ☐ No vehicle registration 26. ☐ Waste is yard waste, brush, asbestos, etc. 27. ☐ Other (please provide an explanation):