NYC 9/11 Public Portal Document
IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
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Owner's name
Dept 01 Envito PlIACtt Jtlime In
Wait and Load
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2. Cttt Qr c Drop Date
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G ~'.St}t~1sC~j ll ly ~ ~ ash c
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R 3. e ^pb t4 IAtation WDS phone number
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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 ^.. G > : !"• r ' BAGS
SIZE • < )';• i CUBIC YARDS
8. Generator Certification
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<. ,'._' i it CE. RT E 1 C ATl 1 C I hereby declare that the contents of this consignment are fury and accurately described
R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper conditionfor transport by
A highway according to applicable international government regulations.
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P 10. Transporter #1 (Acknowledgement of receipt of materials) IJlC Permit No.
O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462
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E Printed/rypedName Title Signature `i Date M/D/Y ,'
1 1 . Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #
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Printed/Typed Name Title '$i nature 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
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Printed/Typed Name
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Title Signature
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Date (M/D(Yj
WH[TE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000099314
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