51 MURRAY ST 1001438, 133/10

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49012 WASTE MANAGE , GENERATORS EPA Region 2 LOGANO : EPA New England 290 Broadway, 26th Floor EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 1 Congress Street New York, NY 10007-1866 (860) 342-0667 • Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 51 UNITED CORP Address Address 3010 BURNS AVENUE 51 MURRAY STREET WANTAGH NY Zip 11793 city • NY 1000 P City State NEW (516)781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 YARD Address MURRAY STREET VOLUME 1 CY Friable Non-Friable p City Bag A Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #. F1059 NEW Y&K• NY 100 '

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. Shippers 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 •

Transporter 1: FIBER CONTROL INC. 3010 BURNS A1 ~1 AUE-WANTAGN NY 11733 516-781.3000 ' Address Telephone # Driver: C. i — Registration #: NY! 480 130 AR Date: 07124)2 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Ma em N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: Registration A O A V Date: S' nature State! # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET • PORTLAND, CT 06480 1 I 1h PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Date: Signature State / # Ackno ledgement of receipt of materials.

Landfill Name: L Phone No: S-3 Location: /~hi~sri Approximate Volume of Asbestos Received: Discrepancy If Any: , ,

Received by: 7-24 -o?-- Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000100317