Waste management and EPA emergency contact information

NYC 9/11 Public Portal Document

U CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49,014 WASTE MANAGEMENT GENERATORS EPA Region 2. LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 TELEPHONE • (860) 342-D667 • 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# '4'ThSjCn ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. CASTEGA -20 VESEY STREET Address 20 VESEY STREET Address 3010 BURNS AVENUE City WANTAGH State NY Zip 11793 City NEW Y MK, NY l000~' (516)7813000 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address VOLUME I CY Friable X Non-Friable ❑ City NEW NY iooifP Bag ( Drum ❑ Wrapped ❑ Other ❑ Phone Number INV # F1059 RQ, ASBESTOS, 9, NA2212, PG III 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 as defined by 40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to 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 classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE___________________________________________ Transporter 1: FIBER CONTROL INC. WANTAGH, NY 11733 516-7813000 Name Address Telephone # Driver: /1NI Registration # NY ! df30139 AR Date: 07124A2 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste N.E.E.T.. Inc.. PO Box 1

Driver: #: ~~ ~~~~/ øt- . Date: State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET• PORTLAND, CT 06480 I _ PHONE: (800)272.3867 PERMIT # SW 1130223 Received By: • Certification of receipt of materials covered by this manifest.

Transporter 3: Address I eiepnone rs

Driver: Date: State / # of receipt of materials.

Landfill Name: hone No: Location: Approximate Volume of Asbestos Rece Discrepancy If Any: Received by: 7-z- oz Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000112142