NYC 9/11 Public Portal Document
• Y DiM NYDEC - NJ,344'
DJM NJ MP 18693
109-113 Jacobus Atie.
DOCUMENT NUMBER AB
31551
S. Kearny, NJ 07032 ,r
ASBESTOS WASTE SHIPPING DOCUMENT
1. WORK SITE AND MAILING ADDRESS Owner's Name Owner's Telephone No.
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N -i N i , ►1•ERt©2 PAiClz'Se V
2. OPERATOR' NA E AND ADDR . Operator's Telephone No.
CoP 1/8, / vwco
/L/ /2? o /E &qe,&'r /J
3. WASTE DISPOSAL SITE (WDS) Mailing address an hysrcal}Ste L cation WDS Telephone No.
GREENRIDGE RECLAMATION lam"
LANDFILL ROAD
(724) 887-1370
SCOTTDALE, PA. 15683
4. NAME AND ADDRESS OF RESPONSIBLE AGENCY
USEPA Air Compliance Branch,1Region II
0
290 Broadway
New York, NY 10007
w 5. DESCRIPTION OF ASBESTOS MATERIALS 5A. saw 6. CONTAINERS 7. TOTAL QUANTITY
z
Circle as appropriate, percentages must total 100% Approval No. No. T 7 cu. yd,
(W
7
FRIABL ~00 %
NON-FRIABLE
8. SPECIAL HANDLING INSTRUCTIONS: (Friable Asbestos Only) Waste double bagged and prewetted with an approved
wetting agent. Asbestos, 9, NA2212,111, RQ DEP Waste Type ID27A
9. OPERATOR'S CERTIFICATION: I herby declare that the contents of this consignment are fully 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 government regulations.
Printed / Typed Name and Title. I Signature: Date:
10. TRANSPORTER 1 (Acknowledgement of receipt of materials)
11. WASTE TRANSFER SITE - Owner or Operator
Certification of receipt of asbestos materials covered by this manifest except as noted in item 13.
Printed / Typed Name and)tle - Ad jsss & Telephone No. Signature: Date:
~
Clean Earth, Inc. (973) 3444004
115 Jacobus Ave: South Kearny, NJ 07032
12. TRANSPORTER 2
Printed / Typed Name and Title - Address & Telephone No. Date:
Signature:
LUSO TRANSPORT CO. 1 )
169 Blanchard Street
Newark, NJ 07105 ,, 11~
Dept No. 20514 ' A Decal No. N
13. DISCRERANG' 4DICATION SPACE
14. WASTED5SPOSAL SITE - Owner or Operator
Certification'Qf receipt of asbestos materials covered by this manifest except as noted in item 13.
Denise L. Rugg
Printed / T~ R`ed Name and Title - Address & Telephone No. Signature:
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Scale O tetor
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NYC-WTC 000112275
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