NYC 9/11 Public Portal Document
.. NY DE`C 1A-371 3 / NYDCA 483056
.QQbeLoP-9rranesporLdion ., Inc.
P.O. BOX 1044 TOLL FREE PHONE 631-924-5050
HAMPTON BAYS, N.Y. 11948 1-800-755-OATC FAX 631-924-5085
"EMERGENCY NUMBER"
Waste Manifest # Job # Floor or Location Cust # ; 2
1."Work Site Name and Mailing Address Owner's Name, Address, Phone Number
CENTURY REAL I TV INC.
.. _NA SA
— T. 53 NASSAU ST.
NEW YORK. N.Y. x. . . `' . . .
Contractor's Name, Address Waste Disposal Site
TRIO MF:1i •'
.iW. _..._ L A.\D._ .....
. STREET
• 20 129T RT. -_. BO`: 6E'
• OLL:aE POINT. NY BRIDGE PO.T WV. :f... ;O
Name and Address of Responsible NESHAPS Agency Other O
U.S. EPA REGION 11, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials Bags- Cubic Ids. -
Q Waste Asbestos, Class 9, NA2212, PGIII 0 Other Drums or Tons -
OTHER -
0 RQ Waste White Asbestos, Class 9, UN2590, PGIII
Special Handling Instructions and Additional Information
OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper
shipping name and are classified, packed, marked and labeled and are in all respects In proper condition for transport by highway according to
applicable international government regulations.
t77 - X h0 JO"L
rinted/Typed Name Tie -SF' re ate (M/DD/YY)
Transporter 1 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Name: Date
HAMPTON BAYS, NY 11946 1~~~
Title: RIIV R
Transporter 2 (Acknowledgement of Receipt of Materials)
- Telephone No.
Company Name and Address SI e.
ASBESTOS TRANSPORTATION CO., INC. 631-924-5050
P.O. BOX 1044 Printed Name: t" D
HAMPTON BAYS, NY 11946
Titre: DRIVER
Discrepancy Indication Space:
Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Accepted)
Telephone No.
`E IDOWF I LL LANDF _ -i Signature:
f I .4 , 1
_ I _: v ; .. 42_2 Date
Printed Name:
Company Name and Address Titis:
NYC-WTC 000099543
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