NYC 9/11 Public Portal Document
NYCEC 1A-371 -
37
NYDCA 483056
-
ransportation o., 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 # Ijob # Floor or Location ICust # 12
1. Work Site Name and- Mailing Address Owner's Name, Address .Phone umberL
V LL PYNE CONPAN I ES _TD
30 WALL ST. 30 WALL ST.
NEW YORK, N.Y. NEW YORK, N.Y.
Contractor's Name, Address Waste Disposal Site
TRIO \1EADOWFILL LANDFILL
14-20 .12Y)TH STREET RT. #2, BOX 68
COLLEGE POINT, NY BRIDGEPORT, WV. 26330
Name and Address of Responsible NESHAPS Agency Other U
U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials Bags - Cubic Yc, -
RQ Waste Asbestos, Class 9, NA2212, PGIII 0 Other Drums or Tons- O E
❑ 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.
Printed/Typed Name Title Signal
7/4('
Date (M/ D/YY
ô
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 Printed Name: Date
HAMPTON BAYS, NY 11946
Title: DRIVE
Transporter 2 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Si ure /j 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Name: J (^ Die
HAMPTON BAYS, NY 11946
Discrepancy Indication Space:
Title: DRIVER T7 /4
Waste )Disposal Site Owner or Operator's rtification (Receipt of Above Waste Accepted)
Telephone No.
1E.ADOWFILL LANDF1 LL Signature: ~
1(304)542-2:54 Date
Printed Name:
Company Name and Address Title: S 7-2 f~
NYC-WTC_00011233
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