49 MURRAY ST 1001437, 133/7503

NYC 9/11 Public Portal Document

ERA. AGENCY NY GENERATORS #99 49011 CT, MA, RI, VT, NH, ME WASTE MANAGEMENT GENERATORS EPA Reyyorr2 —s LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box,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# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 49 MURRAY HOUSE CONDOMINIUM 3010 BURNS AVENUE Address 49 MURRAY STREET Address City City WANTAGH State NY Zip 11793 NEW TtlRK. NY 100(*p (516)781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address 49 MURRAY STREET ° VOLUME 1116 CY FriableX Non-Friable El City NEW Y&K. NY 1001' Bag j$( Drum ❑ Wrapped ❑ Other ❑ Phone Number INV # F4059 i 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 T ~

Transporter 1: FIBER CONTROL INC. 3010 BUR NUE NTAGH. NY 11795 516781 Addr Tele hone # Driver: 1ttlAi1 l Registration #: NY 1480 139 AR Date: 07f24A32 Signature State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: ~`,/ Date: -~S Signature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC.* 203 PICKERING,STREET • PORTLAND, CT 0648 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 / # Ac owledgement of receipt of materials.

Landfill Name: Phone No: Location: Permit Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Date: 7_...2 G D3 Certification of receipt of materials covered by this manifest.

COPY 1 - G ._--iATOR

NYC-WTC 000100364