NYC 9/11 Public Portal Document
NYDEC 1A-371 37
NYDCA 483056
0/ /r"IamporLation
CQ-AbekoQ5 C~ po., 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"
• WaJe Manifest # Job # Floor or Location Cust #
1. Work Site Name and Mailing Address Owner's Name, Address, Phone Number
TRtDEL FOOD STORES INC.
49 NASSAU ST. 49 NASSAU ST.
NEW YORK, N. V. N.Y. , N.Y.
Contractor's Name, Address Waste Disoosal Site
:,
.~. .•fE_l_ O~tiF. -;. ...\\D5' I LL
4-20 . _ 9T =- STREET RT . =2. BOX 68
^OLLEGE I'C??T\T, NY BRIDGEPORT, Wt'. 26330
Name and Address of Responsible NESHAPS Agency Other O
U.S. EPA REGION 11, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials IBags - Cubic Y
RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other
1Dnzns or Tons - OTHE -
❑ 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.
________
Printed/Typed Name
#*wA
Title
Cc - x -- ,~-m ,. a
nature Date (M D/Y )
Transporter 1 (Acknowledgement of Receipt of Materials)
Company Name and Address Telephone
Signature:
ASBESTOS TRANSPORTATION CO., INC. ne No.
-924-5050
P.O. BOX 1044 Printed Name: Date
HAMPTON BAYS, NY 11946
Title: D R 'i - f
Transporter 2 (Acknowledgement of Receipt of Materials) 7'
e .0 _ ._' 4
Company Name and Address Telephone No.
ASBESTOS TRANSPORTATION CO., INC. 631-924- 50
P.O. BOX 1044 Printed Name:" 1 D
HAMPTON BAYS, NY 11946
Title: DRIVER ~ aG 4
Discrepancy Indication Space:
Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Accepted)
!E aDOWF I LL LANDFILL Telephone No.
Signature:
1(304)S42-234
Printed Name: Date
Company Name and Address Tide: S 7 Z t- Q
NYC-WTC 000099786
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