Asbestos disposal form, WTC site, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY NY GENERATORS #99 49010 CT, MA, RI, VT, NH, ME WASTE MANAGEMENT GENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box 144 • Portland, CF 06480 TELEPHONE ($60)342-0667 • Fax:(860)342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. ANDREWS BUILDING CORP Address 382 LAFAYETTE STREET Address 3010 BURNS AVENUE City NEW flit. NY 1 p City WANTAGH State NY Zip 19793 (516)781 Phone Number Telephone Number 0642&82 0Tf I2 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container inn YAR1 Address VOLUME 1115 CY Friable ( Non-Friable ❑ City Other ❑ NEW C ORK. NY 10 Bag% Drum ❑ Wrapped ❑ Phone Number INV t F1059 RCS, ASBESTOS, 9, NA2212, PG III I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law, is not a hazardous waste as defined by 40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150. Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE _ - tiJ~M Transporter 1:

Driver: Registration #: NY 1480139 AR Date: 07T2►4102 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: E.E.T.. Inc.. PO Box 1

Driver: Registration #. 0 99////fr.-f _Dater Date: Z-- ia re State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET • PORTLAND, CT 06480 V t — PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: I Certification of receipt of materials covered by this manifest.

Transporter 3:

Driver: Date: Signature State / # of receipt of materials.

Landfill Name: i3

Location: Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000100163