NYC 9/11 Public Portal Document
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ESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
11495 DATE '7 (7/
I. ,);oh S i t;: .A, ' _... Owner's name Wait and Load
$qt ?+ta U StrEt Dgit Of a'-'tt0 Protect me In
New Vott. .N. V Time Out
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c't fl` `IIaCxi t4t :. Drop Date
l2 8 Rilp Avenue
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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 /' ç1 ; '-'- ' BAGS
SIZE r' CUBICYARDS
8. Generator Cenification
'T I l`OC . I hereby declare that the contents of this consignment are ftsy and accutely 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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Printed/Typed Name Title Signature Date (M/Dr.
P l0. Transporter #1 (Acknowledgement of receipt of materials) Permit No.
O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462
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Printed/ryped Name Title ,f
Signature .,.f Date M/D/Y
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #
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,I Printed/Typed Name Title Si 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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Date(M/D/Yf
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000099306
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