NYC 9/11 Public Portal Document
NYDEC 1A2371
37
NYDCA 483056
CQ,/csbe(BLo(5 /ran8portakion 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 # Job # Floor or Location Cust # ' _' _
3'"
1. Work ite Name and Mailing Address Owner's Nau q,
.. V
dress,; Phor q
al i.L+_ (_.,
um
....
`
' S• ~• F
.~
, ,. .
%_t71:.7 .1-•. i ...
30 W A L ._. J T. WALL ST.
.30
NEW YORK. N. . . NEW YORK N.V.
Contractor's Name, Address Waste Disposal Site
TRIO MEADOWFI. LT. LANDFILL
--20 2 1
.'t'E_ _ hT. , BO-X 6
COLLEGE POINT. N':' BRIDGEPORT WV. 26330
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 Y -.
RQ Waste Asbestos, Class 9, NA2212, PGIII O Other
Drums or Tons - 0151E _
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.
X D
Printedlryped Name itle ignature Date / D/YY
Transporter I (Acknowledgement of Receipt of Materials)
• Telephone No.
Company Name and Address Signature:
ASBESTOS TRANSPORTATION CO., INC. 631-924-5050.
P.O. BOX 1044 Printed Name: Date
HAMPTON BAYS, NY 11946
Title: 7 DRIV 12 i
Transporter 2 (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Si ure 631-924-5050
ASBESTOS TRANSPORTATION CO.,' INC.
P.O. BOX 1044 Printed Name: r D to
HAMPTON BAYS, NY 11946
Title: DRIVER ;/' '
Discrepancy Indication Space:
Waste pisposal Site Owner or Operators rtification (Receipt of Above Waste Accepted)
. T DF I Telephone No.
r. F LL
N EADO1k_ LANDFILL
L Signature:
Date
Printed Name: j)J
Company Name and Address Title:
S i2
NYC-WTC 000112339
OCR can misread numbers and units. Confirm readings against the page image before using them.