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

NYC 9/11 Public Portal Document

NYDEC 1A-371 NYDCA 483056

sbestos d =/*/ran8porLaUon o., Inc. P.O BOX 1044 TOLL FREE PHONE 631-924-5050 HAMPTON BAYS, N.Y. 11946 1-8CO-755-OATC FAX 631-924-5085 "EMERGENCY NUMBER"

west,: Mani'3: # - — job # or 229 1. WorK Site Name and Mailirg Address Owner's Name, Address, Phone Number NYC—DEP 114 LIBERTY ST. 59-17 JUNCTION BLVD. NEW YORK, NY FLUSHING, NY Contrjc!c' s Name, Address Waste Disposal Site

ETS MEADOWFILL LANDFILL 160 CLAY STREET RT. #2, BOX 68 BROOKLYN NY 11222 BRIDGEPORT. WV. 26330 Namn and Addms, of Riisponsib!e NESHAPS Agency Other ❑

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 D 4,crption of Matcr•31s Bags - 'Cubiic Yds. - RQ Taste Asbestos, Class 9, NA2212, PGIII J Other DO k Drums or TonsOTER J RQ Waste White Asbestos, Class 9, UN2590, PGIII Spec:a Hanc ng Inst•uctions and Add tional Information

OPEPATOP S CERTIFICATION • I hereby declare that the contents of ~t cons gnment are and accurate y described above by proper ;>h ipp ^g name and are class,fied, packed, marked and labeled and are in a respects in proper lion for transport by higiway accord rig to app! cable international government rogulations.

fiAz j , &w7( c/oc7' Pn,ited, ped Nam Tit e Sigr Date 'MIDD/YY) .

Tr rnnrter 1 (Ac,r-w udgement of Receipt of Materials) Telephone No Company Name and Address Signature: A f 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. - P.O. BOX 1044 Printed Name• Date IIAMPTON BAYS, NY 11946 Ti 'e DRIVER Tr.,nsport'r 2 (Acknowledgement of Receipt of Materals) Telephone No Comc.3ny Name and Address Signature 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 Pr need Name: C 7fJ*- ten ate HAMPTON BAYS, NY 11946 Title. DRIVER D ' crnpancy irdica• n Space

Waste Disposal Jca'.on (Receipt of Above Waste Accepted) MEADOWFILL LANDFILL I 1(304)842-2784 S gnature Printed Name: Date

Ccmpany Name and Addrrss Title: GA

NYC-WTC 000100770