Lab report cover sheet for waste transport, 114 Liberty Street,

NYC 9/11 Public Portal Document

NYDEC 1A-371 NYDCA 483056

-7c1 6-,(4/,sbcAo,s ansportation o., Inc. P.O BOX 1044 TOLL FREE PHONE 631-924-5050 HAMPTON BAYS, NY 11946 1-800-755-OATC FAX 631-924-5085 "EMERGENCY NUMBER"

Waste Manifest # Ijob # Floor or Locaton Cust #

1. WorK Site Name and Mailing Address Ow r~s N15i a Address, Phone Number

114 LIBERTY ST. 59-17 JUNCTION BLVD. NEW YORK, NY FLUSHING, NY Contractors Name, Address Waste Disposal Site ETS MEADOWFILL LANDFILL 160 CLAY STREET RT. #2, BOX 68 BROOKLYN, NY 11222 BRIDGEPORT, WV. 26330 Name and Address of Ruspors b,3 NESHAPS Agency Other 0 - - _-

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Descrip' on of M3te•ials IBags- A RQ Waste Asbestos, Class 9, NA2212, PGIII J Other Drums or Tons - OTHER - J RQ Waste \4 hite Asbestos, Class 9, UN2590, PGIII Spec 31 Handling instructions and Addit:onal Informat on

OPERATOR'S CERTIFICATION I hereby declare that the contents of th onsignment are fu,ly and accurately described above by proper shippmq name and are classif'ed, packed marked and labeled and are in respects in proper con Ilion for transport by h ghway according to applicable interna"onal government regulations.

Printedlyped Name Title Signature Date (MiDD/YY) Tran;,pertcr 1 (Acknowledgement of Rece pt of Materials) Telephone No. Company Name and Address S gnature. 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 Printed Name: Date HAMPTON BAYS, NY 11946 ITitle. DRIVER I Tra^ porter 2 (Acknowledgement of Receipt of Materials) Telephone No. Compa^y Name and Address Signature: 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. ~/ P.O. BOX 1044 Printed Name • (,4,j'i SG/~,v Date JHAMPTO" BAYS, NY 11946 Title: DRIVER Disc•ep.nuy Ina :ration Space

MEADOWFILL LANDFILL Waste Disposal Site Owner or perato%s erti!,cat;on (Receipt of Above Waste Accepted) 1(304)842-2784 Telephone No. Signature

Printed Name: Date

Company Name and Address Titre: 17

NYC-WTC 000100769