NYC 9/11 Public Portal Document
NO Nlr 4C 1A-371 ' ' 37 NYDCA 483056
besto s . C~/rane5porLabon o., Inc.
P.O. BOX 1044 TOLL FREE PHONE 631-924-5050
HAMPTON BAYS, N.Y. 11946 1-800-755-OATC FAX 631-924-5085
"EMERGENCY NUMBER"
Waste Manifest #
69i~ 1 . Job # Floor or Location Cust # ,
CEAl'iU Ry RE;i. J . J iNi.
53 Ns s : s7. 3 A'JSAUST.
AEW YOiii . X.Y.
N.Y.
Contractor's Name, Address Waste Disposal Site
!R 10 V;F.ADO11'i ILL ..AYI) '
0i F:,Cf. PO1 NT. NY Br1DG> P(?r.T. WV . 2f• 330
Name and Address of Responsible NESHAPS Agency Other O
U.S. EPA REGION II, 290 BROADWAY. NEW YORK. NY 10007
Description of Materials Bags - Cubic -
RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other `
Drums or Tons - OTHER -
U 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
shipping name and are classified, packed, marked and labeled and are in all respects In proper condition for described above by proper
transport by highway according to
applicable international government regulations.
nntedlryped Name T e A re to (M/DD/YY)
Transporter 1 (Acknowledgement of Receipt of Materials)
Company Name and Address Telephone No.
ASBESTOS TRANSPORTATION CO., INC. Signature: 631-924-5050
P.O. BOX 1044 Printed Name: Date
HAMPTON BAYS, NY 11946
Titie: RIV R 'TIJL
Transporter 2 (Acknowledgement of Receipt of Materials)
Company Name and Address — Telephone No.
SI re:
ASBESTOS TRANSPORTATION CO., INC. 631-924-5050
P.O. BOX 1044 Printed Name:
HAMPTON BAYS, NY 11946
Discrepancy Indication Space:
Title: DRIVER
A7
(
Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Accepted)
I ?_:._ .L..•\NJ. F : . . Telephone No.
Signature:
Printed Name: Date
Company Name and Address Title: 5'
NYC-WTC 000099542
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