NYC 9/11 Public Portal Document
NYDEC 1A-371 NYDCA 483056
CQ/kcAas JrarisporLaLion 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 Gust # 1 22
C593
1. Work Site Name and Mailing Address Owner's Name, Address Phone Number
U.S. IMEF~T. OF I.N.P. S.
26 WALL ST. 26 WALL ST.
NEW YORK, NY NEW YORK, NY
Contractor's Name, Address Waste Disposal Site
TRIO
14-20 1 29TH STREET MEADOWFILL LANDFILL
COLLEGE POINT, NY RT. r 2. BON 68
RA FD RT lA7V 6 1(1
Name and Address of Responsible NESHAPS Agency Other ❑
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 - OTHER -
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.
a/V ~ 1~11"1 l~ldl~iIsLo-i~-~~~ X /
Printed/Typed Name Title Sig a r Date (MIDD/YY)
Transporter 1 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Prints a Date
lc
HAMPTON BAYS, NY 11946
Title: DRIVER . O2-oZ.
Transporter 2 (Acknowledgement of Receipt of Materials)
~ Telephone No.
Company Name and Address
Signature: ,st_ce- ./ 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Name 79,n '2 "RA /S' 74 2 9~e®
HAMPTON BAYS, NY 11946 7
Title: ' DRIVER
Discrepancy Indication Space:
Waste Disposal Site Owner ator's Certification (Receipt of Above Waste Accepted)
Telephone No.
Signature:
MEADOWF1 LL LANDFILL
Printed Name: Date
1(304)842-2784
Company Name and Address Title:
.7-5-/
NYC-WTC 000112252
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