NYC 9/11 Public Portal Document
-}f TRI-STATE TRANSFER ASSOC., INC.
1199 Randall Avenue
Bronx, New York 10474
718/ 617-0771 - Fax: 7*/ 378-5858
MANIFEST NO. 31629
JBT. NY DEC 1A375
NJ DEP SW1896
NON - HAZARDOUS WASTE MANIFEST DATE 09-26-2002
D.E.C.1A-375
D.EC.2A-456
FRIABLE AT POINT OF ORIGIN, DOUBLE BAGGED AND MADE NON-FRIABLE FOR HANDLING AND TRANSPORTATION.
(FRIABLE ASBESTOS ONLY).ASBESTOS ,9.NA2212,111,RQ DEP WASTE TYPE ID27A
USEPA AIR COMPLIANCE BRANCH, REGION 11290 BROADWAY NEW YORK, NY 10007 212-637-4249
120 LIB ERTY LLC 97-77 QUEENS BLVD. FLUSHING NY 11374 (516)781-3000
BUILDING OWNER'S NAME AND MAILING ADDRESS PHONE NO.
NYC-DEP 125 CEDAR STREET NEW YORK NY
SITE OF GENERATION (if different from mailing address) DEPT. NO.
I.B.T DEC#1A-375 OR TRI-STATE TRANSFER ASSOC. INC DEC#2A-4561199 RANDALL AVENUE BRONX, NY 10474
ASBESTOS HAULERS COMPANY NAME
TO T S A TE
sau .aaTn 1199 RANDALL AVE. BRONX, NY _I0474_718-617-0771
TRANSFER ASSOC. INC 2-6007-00006/1
TRANSFER STATION DISPOSAL FACLITY PRRMTT NO. (1 I digits) ADDRESS PHONE #
BFI IMPERIAL LANDFILL 11 BOGGS ROAD, P.O. BOX 47 IMPERIAL, PA 15126(724-695-0900)100620
DESIGNATED DISPOSAL FACILITY NAME, SITE ADDRESS, TELEPHONE NO., & PERMIT NO.
ROLL-OFF (1) 40 CYDS TRL 40 CYDS TRL _
TYPE OF CONTAINERS NO. OF CONTAINERS UNITS (WT. !VOL.) QUANTITY
FIBER CONTROL INC.
ABATEMENT COMPANY NAME
3010 BURNS AVENUE WANTAGH NY 11793 (516)781-3000
ABATEMENT COMPANY ADDRESS PHONE NO.
PROGRAM MANAGER'S NAME PROGRAM MANAGER'S AFFILIATION
PRINT E NAME TI SIGN M0./DAY/YR
BUILDING OWNER'S CERTIFICATION: I CERTIFY THAT THE ABOVE DESCRIBED WASTE CONTAINING ASBESTOS IS
FULLY AND ACCURATELY DESCRIBED AND HAS BEEN THOROUGHLY WET DOWN, PACKED AND LABELED IN
FULL COMPLIANCE WITH THE PROVISIONS OF SECTION 16-117.1 OF THE ADMINISTRATIVE CODE OF TH , CITY
OF NEW YORK AS AMENDED BY LOCAL LAW 21 OF 1987.
(.t/ fl yLIv/L If fib 0
PRINT/TYPE NAME ON BEHALF OF HAULING COMPANY TITLE SIGNATURE O/DAYfYR
jJ ASBESTOS HAULER #2 ACKNOWLEDGEMENT QUA jt GEIPT OFD ~` ~1 ~DESGRIB QV ,~
DISCREPENCY INDICATION SPACE
71 U~ ~nrr~ic ~YYI ~v1s .Z z — c
DESIGNATED DISPOSAL FACILITY'S OWNER OR OPERATOR CERTIFICATION OF RECEIPT OF WASTE COVERED
BY THIS MANIFEST, EXCEPT AS NOTED IN THE DISCREPANCY INDICATION SPACE
1ST COPY
NYC-WTC 000108040
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