NYC 9/11 Public Portal Document
E.P.A. AGENCY #99 49014
CT, MA, RI, VT, NH, ME NY GENERATORS
WASTE MANAGEMENT GENERATORS
EPA Region 2
LOGANO EPA New England • 290 Broadway, 26th Floor EMERGENCY RESPONSE
i Congress Street New York, NY 10007-1866
P.O. Box 144 • Portland, CT 06480 TELEPHONE
(860) 342-0667 • Fax:(860) 342-4866 Boston, MA 02114-2023 (212) 264-6770
Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867
FB# ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number .0. # GENERATOR/BUILDING OWNER
Contractor FIBER CONTROL INC. CASTEGA -20 VESEY STREET
Address 20 VESEY STREET
BURNS AVENUE
Address 3010
City NEW Yd K, NY 1000 p
WANTAGH State NY Zip 11793
City
Phone Number
(516)7813000
Telephone Number
GENERATING LOCATION
Date Container Del. Date of Pickup
Type of Container 100 YARD Address
VOLUME 1 CV Friable X Non-Friable ❑ city
NEW V&W. NY 1001ff
Bag$ Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #- F1059
as defined by
I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law, is not a hazardous waste
been property described, classified and packaged, and is in proper condition for transportation according to
40 CFR part 261 or any applicable state law, has
NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150.
Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are
international and national
classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable
government regulations.
AUTHORIZED SIGNATURE
Transporter 1: FIBER CONTROL
nuuiesa Telephone #
Name
Registration #: NY 1480139 AR Date: 07/24!02
Driver:
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste Man m N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Registration #: [/~ ~1` Date:
Driver:
Signature State / # ,/>L
Acknowledgement of receipt of materials.
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 0648
- • — PHONE: (800) 272-3867 PERMIT # SW 1130223
Received By:
Certification of receipt of materials covered by this manifest.
Transporter 3: Telephone #
Name Address
Driver: istration #: Date:
State / #
of receipt of materials.
Landfill Name: No:
Location: l rmit
Approximate Volume of Asbestos Rece
Discrepancy If Any:
Received by: v —~ 7-z6 - OZ
Certification of receipt of materials covered by this manifest.
r,7' '2EN: Al .
NYC-WTC 000112141
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