NYC 9/11 Public Portal Document
°IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
11247
I. Job Site Address Owners name Wait and Load
111 Nassau Street Dept Of Envl c ent Time In
New Yele('k, N.Y. Protection Time Out
2. C r ~r s n a addrebs & Drop Date
1248 Ralph Avenue
GE Brooktyn, NY 11236
N
E
R 3. ~tion WDS phone number
A P.G. BOX 319 -
o Scotland, Pa. 17254 Permit # 100334
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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, NA 212, III TYPE ' BAGS
SIZE CUBIC YARDS
8. GeneratorCetafication
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.
NS Printed/r Name Title Signature Date (M/D/ 3 t
P GAP
10. Transporter #1 (AGrnowtedgemem of receipt of moerialo) DEC Permit No.
O
R IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462
E Printed/Typed N me
41'L DRiVER
Title Signature Date M/D/Y
__7 ( ( I 0
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #
W
T Printed/rypeo Name Title Si an Date (M/DIY)
E 12. Discrepancy indication space
S
I
T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
Printed/ryped Name Title 4Snte
itJ 1w
-
7! t
Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINKO NERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000099072
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