NYC 9/11 Public Portal Document
Manifest 2. Page 1
1. Generator's US EPA ID No. DocumeniNo. of
NONHAZARDOUS
WASTE MANIFEST .~ _.', r.,
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Mailing Address
3. Generators Nome and
`'r' r~'t
4. Generator's Phone A. Transporter's Phone
6. US EPA ID Number ;
5. Transporter 1 Company Name .:. ';` i !~! . if
B. Transporters Phone
S. US EPA 1D Number .c ..r'. .: 17a,~
Company Name
7. Transporter 2Com •.i . 'v .
t ia. 6. ~. ~t . r; .
_{ , fit;; + f`n 1 t 4, .a '- . U C. Facility's Phone
lO, US EPA ID Number
9 Design6ted Facility Name and Site Address
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1; i t ' y~ i? 12. Containers
Tot13al 14.
No. Type Quantity Wt V
11• Waste Shipping Name and Description
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Above
E. Handling Codes for Wastes Listed
F
criptions for Materials listed Above is
AMitional
Information
15. pc ling Instructions and Additional
te.
for reporting
I certify the awtarials deembed above on this ar
16. GENERATOR'S CERTIFICATION:
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' /ypet
Prinfed amS
5
Materials
Trnnenort 1 Acknowledgement of Receipt of ar
M
` now edgement of Recei t of Materials ear
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ad Na
Indication Space
manifest ezcept1s noted in Mem 1 .
receipfof waste materialscovered by thii
r i ~ er or Operotor: Certification of
/i. st...rA Gov Year
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Y tt SignatUte, } / ! f
insect/Typed Name i 1
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r1Arar:DnRTFR #1
NYC-WTC 000108281
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