NYC 9/11 Public Portal Document
Emergency Contact Telephone Number
UNIFORM HAZARDOUS 1. Generator's US EPA ID No. D nhlerN 2. Page 1 Information in the shaded areas is
• • • • . • . . . . . . , of not, re xired by Federal law.
WASTE MANIFEST
3. Generator's Name and Mailing Address 1. + ;. i !{r:.1'+ l Y L. L., :: •.. A. Stale Manifest Document Number
Ni W Lr [ 0 i ! T It B. State Generator'S ID
4. Generator's Phone ( )
5. Transporter I Company Name 6. US EPA ID Number C. State Transporter's 1D ' "37
c ki l , : 4 :; ' T D. Transporter's Phone ( ter 1 , J ' 4 i — . 'A
7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID t,,-37
, x. r4 c t )
Hi iarl x r'll[ t{a?eSj; :.r:=. s ~v r ' . fii riF~ F. TranaportersPhore l5 ~r '&i - '3 O
9. Designated Facility Name and Site Address 10.' US EPA ID Number ' G. State Facility's ID
i~ i ,:IAI ..tia_te (.. ;:,, ,:I NY2i?•--2129 x
42— i i'.7f: ?-; v } st U:: H. Facility's Phone
f•)5i]1'ica NNY z1i i', ii 'r i tct i 1 . 4 o rc: 6 = (71B) 274-3339
11. US DOT Description (Including Proper Shipping Name, Hazard Class, andID Number) 12. Containers 13. 14.
Total Unit 1.
M No. Type Quantity WtNol Waste No.
a. tl'. G le.S.rit F3 -: ,...`P'3 ,''".cater'-i t1. 3 1
✓ i2t.2. PG ' .. (st rpi r 11ii. F3,.oi .`:•I F.ai~e4 ai
G b.
E
N
E
R
A C.
T
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R . . . .
d.
J. Additional Descriptions for Materials Listed Above C. K. Handling Codes for Wastes Listed 40ve
d.oii Paints/Thinnet^5 . A. ~ c.
b.
15. Special Handling Instructions and Additional Information
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are My and accurately described above by proper shipping name and are classified,
packed, marked, and labeled, and are In all respects In proper condition for transport by highway according to applicable international and national governmental regulations.
If I am a large quantity generator, I certify that I have a program Ni place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
practicable and that I have selected the practicable method of treatment storage, or disposal currently available to me which minimizes the present and future threat to human health
and the environment; OR, If I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that Is
available to me and that I can afford .
PnntedQypad Name ) , Signatu) - 7p Month Day Year
T 17. Transporter 1 Acknowledgement of Receipt of Materials
R .- + 1 '
, r c ypedAlame ..-m SiggatUt ' /`. Month Day Year
N r .~. -.z___~.~ .t
O 18. Transport
R 2 ment Of tot Materials '
T P mew. Sigr~qlute , _. - — Month Day Year
>
R s', ( —~
/ _ .
19. Discrepancy Indication Space
F
A
C
1
L 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted Ni Item 19.
Y
:Printed/Typed Name i x 1 ,' >' SlgIture ( ;' Month Day Year
TRANSPORTER #1
NYC-WTC 000108282
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