NYC 9/11 Public Portal Document
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IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
11244 DATE % /0( /o1.
1. Job Site Address Owners name Wait and Load
124 Naai Stred Dept Of Envuoaneftta Time In
New York, N.Y. Protection Time Out
2. Drop Date
' W9Ti tr Ei1a 1SZUi ~t & S
124.8E Ralph Avenue
G Brooklyn, NY 11236
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R 3. $t p ~tion WDS phone number
A P.O.Box3
o Scotland, Pi. 17254 Permit ## 10034
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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. •
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S Printed/Typed Name Title
4 Signature
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Date
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10. Transporter
>~ # 1 t Acknowledeanent of receiPt of materials) DEC Permit No.
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R IESI NY CORPORATION • 110 5th Street, Brooklyn, NY I 15
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E Printed/fyped Na a Title Signature 7 Date(M/D/Y)
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #
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T Print Name Title Si tore Date M/D/Y
E 12. Discrepancy indication space
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T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
Pnnted/fypedName
a ( Y jn.L&:t
Title Signature Date(M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000098745
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