WTC debris inspection form, 86 Nassau Street

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

11495 DATE ? f 2 -7r/ Owner's name Wait and Load

fa6/ ?ddf;; Skre `t Debt O EnvltO PICt d. _nme In New Y~rt#-. N.Y Time Out

2. Drop Date C t t aE 3iS3 + 31t ~!clta

LM Ralph :fir.eau G Brooklyn, NY 1. V E N E R 3. pssd 4th$ JIII' t4U a(d' l ) `tl I&&tion WDS phone number

A PO x )

O s utiisitt, Pa 1 ?. 4 #'owit It 1OO9 4 R

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 c_ .. . / .' ' BAGS SIZE ';, CUBIC YARDS / 8. Generator Certification ,.

T 9. C !:3'; ii - C: FC) {'r: k i i i .' : :+_. . +. 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. (,

S Printed/TypedName Tide Signature Date (M/D v'!r P 10. Transporter #1 (Acknowledgement of receipt of materials) JEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462 R ____u -t-''"L, — l ? v Z. _ / t f✓ - E Printed/Typed Name Title Signature j If Date M/D/Y R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A S Date M/D/Y •I, Printed/Typed Name Title 'Si nature

E 12. Discrepancy indication space

S t. 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 E i JfJ {} / [1( i "?. ► "~: t -`U~f f. t d'Y 1 Ri '~ d L PrintedIryped Name Title Signature . Date (M/D(Y)

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

NYC-WTC 000099326