Invoice for work at 122 Nassau Street, Oct 2002

NYC 9/11 Public Portal Document

` . IESI NY CORPORATION 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

11243 DATE

I. Job Site Address owners name Wait and Load 122 Nis Street Dept Of Environmental Time In Nev 'York, N.Y. Protectiou Time Out i

2. C atr_acctor's name apt add s Drop Date t flJ tillt3 htlrzt & Son 1248 Ralph Avenue GE Brooklyn, NY 11236 N E R 3. VM (gyp RIn it da"Atfblgttion WDS phone number

T P.O. Box 399 - O Scotland, Pa. 172.54 Permd # 100934 R

4. Name and address responsible agency (Local, District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

5. Description of materials 6.VEH. LIC. # 7. TOTAL QUANTITY

(RQ) WASTE ASBESTOS 9, NA2212, III TYPE . BAGS SIZE CUBIC YARDS 8. Generator Certification

T 9. CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A highway according to applicable international government regulations. N S P _____________ PrintedtTyped Name Title A'- Signature Date M/D r ^1 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O R IES~I/^NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462 /

R Printed/ryped Name __________________ Title Signature Date(M/D/Y) 7Jo R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W ` A 1-, S I` `' \ ~~'~"'~ — T PrintedfTypcd Name Title Signatuib Date M/D/Y a.. . E 12. Discrepancy indication space

S

T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12 E a

rinted/Typed Name \ ~r Title tf.~I~ k Signature kLMift ____________

Date (M/D/Y)

WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000098705