NYC 9/11 Public Portal Document
DJM NYDEC•=NJ-344
DJM NJ DEFT' •18693
i¼ ~ 109-113 Jacob-us Ave-
DOCUMENT NUMBER AB
, . 31551
a s °NZ S. Kearny, NJ 07032 k
ASBESTOS WASTE SHIPPING DOCUMENT
1. WORK SITE AND MAILING ADDRESS Owner's. Name. Owner's Telephone No.
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2. OPERATOR'S NA E AND ADDR '' ' Operator's Telephone.No.
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3. WASTE DISPOSAL SITE (WDS) Mailing address and'Physical'Site L cation
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rn WDS Telephone No.
GREENRIDGE RECLAMATION
LANDFILL ROAD (724) 887-1370
SCOTTDALE, PA. 15683
4. NAME AND ADDRESS OF RESPONSIBLE•AGENCY.
USEPA Air Compliance Branch,~Region II
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0 ,290 Broadway
Q New,York, NY 10007
W 5. DESCRIPTION OF ASBESTOS MATERIALS 5A.. S&W' ' 6. CONTAINERS •7. TOTAL QUANTITY.
0 Circle as appropriate, percentages must total 100%' • Approval No. • . No.: .~Ty Z7 cu. yd::
FRIABL
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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. Signature: • Date: '.,
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10. TRANSPORTER 1 (Acknowledgement of receipt of materials) G_'e4 / 4( '
• 11. WASTE TRANSFER SITE - Owner or Operator
Certification of receipt of asbestos materials covered by this manifest except as noted in item 13. .
Printed I Typed Name and Title - Address & Telephone No. Signature: i Date:
02,1 /?-
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Clean Earth, Inc. (973) 344-4004 •
• 115 Jacobus Ave: South, Kearny, NJ 07032 0L
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• 12. TRANSPORTER 2
Printed / Typed Name and Title'- Address & Telephone No. Signature:'• •
' Date:
LUSO TRANSPORT CO ` O~J
169 Blanchard Street 1
Newark, NJ 07105 ~!/ rn r }~
Dept No. 20514 ~~ Decal No. ~U AJ
13. DISCREPANCY~INDICATIONSPACE
14. WASTE I'SPOSAL SITE - Owner or Operator Denise L. Rugg'
• Certificatiol f receipt of asbestos materials covered by this manifest except as noted in item 13.
• Printed / Typed.Name and Title - Address & Telephone No. Signature:
.a, t Scale 0 erator
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NYC-WTC 000112303
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