Invoice for roof cleanup, 11 Rector Street, June 2002

NYC 9/11 Public Portal Document

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NYDEC' 1A-371 NYDCA 483056

~be~to8 d4amp'of`Labon 0.9 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 #

1. Work Sit Name and Mailing Address Owner's Name, Address, Phone Number

w Y l'}: Contractor's Name, Address Waste Disposal Site I (\V' I: L

Name and Address of Responsible NESHAPS Agency Other ❑

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - Cubic iYds. -

RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other s~ Drums or Tons - OTHER - ❑ 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.

~® ill" u✓ Af G ~s e x Printed/Typed Name Title Sig a r Date (M/DD/YY) 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: DRIVER 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: ~~~ /&i ,'' Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal Site Operator's Certification (Receipt of Above Waste Accepted) Telephone No. Signature:

Printed Name: Date

Company Name and Address Title: j~~

NYC-WTC 000113835