Asbestos disposal form, Fiber Control Inc, 2002

NYC 9/11 Public Portal Document

V E.P.A. AGENCY CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT GENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE t P.O. Box•144 • Portland, CT O6480 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE (860) 342-0667 • Fax. (860) 342-4866 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB#` ~' ' i •'j6([} ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 49MURRAY HOUSE CONDOMNIUM 3010 BURNS AVENUE Address 49 MJRRAY STREET Address City NEW WRFC, NY lan P City WANTAGH State_Zip 11793 (5__781-3m Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address STREET VOLUME 1116 CY Friable Non-Friable ❑ City NEW " ILK. NY 1 Bag% RQ, ASBESTOS, 9, NA2212, PG III Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #. F159

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: t ER CONTROL INC. M NY 11795 516-781.3000 Name rel0 ep7Q Driver. _____________________________________Registration NY 1480 139 AR Date: 4*2 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 #. f // ,-~ Date: Signature State/ # Acknowledgement of receipt of materials. .

TEMPORARY STORAGE 1 TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 06480 a ,n PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3:

Driver: Name ('1f Signature Address Registration # State F# Date: Telephone #

Ac owledgement of receipt of materials.

Landfill Name: ; Phone No: 919 4'79' .~ Location: ~s Permit 1 Approximate Volume of Asbestos Received: Discrepancy If Any: ~,. Received by: 1t [f A Certification of receipt of materials covered by this manifest.

COPY 1- GENERATOR NYC-WTC 000100378