NYC 9/11 Public Portal Document
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NYDEC 1A-371 NYDCA 483056
bc(25Lo(B dXrcmsportaLion ., 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 # 22
Cs93 Owner's Nam, Adrgss Phone Number
1. Work Site Name and Mailing Address
2h WALL ST.
Y
:1=. w °i O R.. . Y YEW YORK -
Contractor's Name, Address Waste Disposal Site
TRIO
14-20 ! 9'. . _. 'i ^ ME:1J0WE1! _. LANDFILL
CO i_EG:. :"O7\: \1' RT. =2. BOX 6S
1'V , •'1
apIrOEOPT
Name and Address of Responsible NESHAPS Agency Other O
U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials Bags - Cubic ci.
RQ Waste Asbestos, Class 9, NA2212, PGIII O Other
Dnxns or Tons - OTHE l--
O 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.
LZl froMM
Printed/Typed Name Title
__(2 Aa1S~ x Sig r Date (M/DD/YY)
Transporter I (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Prints ~c
Date
HAMPTON BAYS, NY 11946
Title: DRIVER . o2 OZ.
Transporter 2 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Name 9,?/~ 7.4' /$?9j , J ae
HAMPTON BAYS, NY 11946
Title: DRIVER
Discrepancy Indication Space:
Waste Disposal Site Owner ator's Certification (Receipt of Above Waste Accepted)
Telephone No.
Signature:
'i:AJOWFIL i_A\i.•Fi__
Printed Name: Date
i U -'~ ; _' — = 5=
Company Name and Address Title:
v
NYC-WTC 000112302
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