Asbestos disposal and documentation form, 2002

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49004 WASTE MANAGEMENT GENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 (860)342-0667 • Fax:(860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# '~'n o ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 54 WARREN STREET LLC 3010 BURNS AVENUE Address 1385 WEST BROADWAY Address city NEW "RK. NY 10011p City WANTAGH State---!Y Zip 11793 (516)7813000 Phone Number Telephone Number IY Y /MI

Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address 54 WARREN STREET VOLUME 1116 CY Friable Non-Friable ❑ city NEW ? tK. NY 1001 Bag ( j Drum ❑ Wrapped Other ❑ Phone Number INV * F1059 / RQ, ASBESTOS, 9, NA2212, PG III I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law, is not a hazardous waste as defined by 40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150. Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE 1U~1 Transporter 1: FIBER CONTROL INC. E WANTA I1. NY 11793 516-781.3000 Na a Address Driver: Registration #: NY 1480 139 AR Date: Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste E.T., Inc., PO Box 1

Driver: #: ~! > ~4~~ ~~-C Date: State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET • PORTLAND, CT 06480 - 6 - — - PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3:

Driver: Name Nil Address Registration #: Date: Telephone #

Signatur State / # n ledgem of receipt of materials.

Landfill Name: Phone No: Location: Permit Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: 1 7-c2 Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000113198