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NYC 9/11 Public Portal Document

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~- :1 ~~~~ .^Sc .. of RESPONSIBLE AGENCY ., ~ • ; 4; A C~mpllairosi~f3riah, Rspioe 11 ~r~^ , , . .,, •:s;'r; . 29 . , ,• W S. DESCRIPTION OF ASBESTOS MATERIALS SA. SSW e. CONTAINERS 7 QJ Q W Ord* eta percentagee moat total 100'.1 Approval No. No "1YIPa on e } ` ., ^ 4' • ' 1. ~.. , ., t•~J'•t'1 . :~.!' S!' - n'• ~ l ~ ~ •" {. N4 ~ ~ •~r• 9

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double bep~ed:and `preweead with an p s. SPP~.CI.. AL,1i~►oNDUNG INSTRUCTIONS. {Riess Aebeotoe Only) WasteType } wem t>et r`.::' 9, Asbe9toe, NA7212r1 C, RQ QEP Waste tD27p. ti.?j I ~'

fully and accurately.'. 0. OPE=RATOR'S CERTIFICATION: I herby declare that the conter>ts of this] conslpnment are proper shipping name and are classified, packed marked, and labeled, and are In all respacta in proper oondtion for. hihwsy aocordng to sppIlceto Internalonai and ov.rnrnuflt re ati ne. -t~•" Priraad / 1~►psd Name end Title S hue: '

— 11 fN&( A& 10. TRANSPORTER 1 knowied meat of recei of materiels t 7 VT 11. WASTE TRANSFER SITE - Owner or Operator Ce1tiflaqn of receipt of eeheatoa metedala covered by this manifest except as noted in item 13. •

t] peered I'typed Name and Title. Address R TYlepnone No- SlDnrture:

' 12. TRANSPORTER 2 prWidl Typed Name and Tltk - Address S Telephone No '

tl.11ri'- NJPSP,10 o1~ 100.113 JACOBN9 AVE. oecar No. B.IiEARN1f Nj ~Tf032 INDICATION SPACE r ,;. ~.,. ra 13: QIS Dash 4: 14. WASTE DISPOSAL SITE - Owner or operator noted in item 13. SEP : 9 1 ' • . . ,• Cerdllcaitloin of rec4►fx..of asbestos materials covered by this manifest except as Frond I Typed Name and 05 . Addr3aa a Teiephna No. Slpnati,re: s Ot.:

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NYC-WTC 000097406