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← Document results/DEP Box 34/116 NASSAU STREET Block: 92 Lot: 24 BIN: 1079094 45 Ann St
Document / 7 pages

Asbestos inspection form, 116 Nassau Street, June 2002

Machine-extracted title · confidence 100%

Inspection record for 116 Nassau Street detailing floor F, squad number, and contractor information for the asbestos survey conducted in June 2002.

NYC-WTC_000098887–000098893

Folder label: “116 NASSAU STREET Block: 92 Lot: 24 BIN: 1079094 45 Ann St”

Page image
Scanned page image, NYC-WTC_000098893
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document C .

I

IISI NY CORQ.I~ATION 1p 5Mi Street • .Brooklyn; NX 11215 / Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

DATE 1. Job Site Address owners name Wait and Load

116 Nasau S►treEt Dept of Ens*rottmental Time In N Y New York, NY. Protection Time Out

2. CrAjWjbad adman & Drop Date 1248 Ralph Avenue G Brooklyn, NY 11236 E N

R 3• WDS phone number

A P.D. Box 3s T • Scot}and, Pa. 172.54 Permit # 111493 R

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

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 3 CUBICYARDS 8. Generator Certification

T 9. C NTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R aboveby pvper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A hi a 4cor n to plicable international government regulations. N S Printed/Typed Name Title Signature Date( P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY I L 15 JA-462 R

E Printed/Typed Name Title /Signaure Date (M/D/Y) R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A r_ T E Printed/Typed Name 12. Discrepancy indication space Title Signatu Date (M/D/Y)

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

t . Prntedrryped Name Title Signature t Date (M/D

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

NYC-WTC 000098893

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NYC-WTC_000098893Source: NYC Law Department, mirrored locally

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