Asbestos disposal form, Fiber Control Inc, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY CT, MA, RI, VT, NH, ME NY GENERATORS V1 ASTE 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. $ox 144 • Portland, CT 06480 TELEPHONE (860)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# r j"ALØ ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 51UNITED CORP 3010 BURNS AVENUE Address 51 MJRRAY STREET Address NY Zip 11793 city NEW i6PtK. NY 1000 p City WANTAGH State Phone Number Number____(5 781.3000 Telephone Date of Pickup GENERATING LOCATION Date Container Del. Type of Container 100 YARD Address 51 MURRAY STREET VOLUME 1t$ CY Friable'4 Non-Friable ❑ car NEW NY 100 Bag Drum ❑ Wrapped ❑ Other ❑ Phone Number INV 0. F1059 RQ, 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 •

Transporter 1: Aaaress Telephone # Driver: Registration #: NY 1480139 AR Date: 071242 Signature State / # Acknowledgement of receipt of materials.

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

Driver: #: (?)'3O/// ,4I Date: State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING*STREET • PORTLAND, CT 06480 - ,.. I PHONE: (800) 2723867 PERMIT # SW113= Received By: Certification of receipt of materials covered by this manifest.

Transporter 3: Name I Address relepnone # Driver. 1 ~ Date: Signature State/ # of receipt of materials.

Landfill Name: Phone No: Location: Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: 1 Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000100338