NYC 9/11 Public Portal Document
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NYDEC 1A-371 NYDCA 483056
beLo~ ~ran~portation ., Inc.
P.O. BOX 1044 TOLL FREE PHONE 631-924-5050
HAMPTON BAYS, N.Y. 11946 1-800-755-OATC FAX 631-924-5085
"EMERGENCY NUMBER"
Waste Manifest # Job # Floor or Location Cust #
x93 Owner's Nam , Add. Qs Phone Number
1. Work Site Name and Mailing Address
0. _ .\.N., S. .
C, W..LL S_ . t
WALL ST.
YEW VORY . NY YEW YORK. Y
Contractor's Name, Address Waste Disposal Site
TRIO
I -:O '9'_.. 'i'I:E._ _ M:ADOWF I L... LANDFILL
COLLEGE POINT. NV RT. _ 2. O\ ÔS
E IL'C'EPORT U'\
Name and Address of Responsible NESHAPS Agency Other 0
U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials Bags- Cubic
RQ Waste Asbestos, Class 9, NA2212, PGIII 0 Other
Drums or Tons - OTHE -
0 RQ Waste White Asbestos, Class 9, UN2590, PGIII
Special Handling Instructions and Additional Information
OPERATOR'S CERTIFICATION: I hereby 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 government regulations.
Pi koMM
Printed/Typed Name Title
J bJse x Sign r Date (M/DD/YY)
Transporter 1 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
Date
P.O. BOX 1044 Prince ~c (,~~
HAMPTON BAYS, NY 11946
Title: DRIVER 2- O
Transporter 2 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: s~ 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Name- Alo "' 'VV A & \T
!
HAMPTON BAYS, NY 11946
Title: DRIVER
Discrepancy Indication Space:
Waste Disposal Site Owner ator's Certification (Receipt of Above Waste Accepted)
Telephone No.
Signature:
`` Printed Name: Date
i 304)542-2 S 4
Company Name and Address Title:
NYC-WTC 000112276
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