Asbestos disposal documentation form, 113 Reade Street, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 48744 CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT GENERATORS EPA Region 2 • LOGANO EPA New England 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 1 Congress Street (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# j; `LLD ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATORBUILDING OWNER Contractor FIBER CONTROL INC. 107W. BROADWAY REALTY CORP 3010 BURNS AVENUE Address 113 READE STREET Address WANTAGH NY Zi p 11793 city NEW MM. NY 1001 P City State (518)781-0000 Phone Number Telephone Number __...._... Date Container Del. Date of Pickup GENERATING LOCATION 13 Type of Container - 100 YARD Address 1 READES7TEET

VOLUME 112 CV Friable Non-Friable ❑ City NEW öVIc. NY 100& Bag . Drum ❑ Wrapped ❑ Other ❑ Phone Number F1041 INV #. 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 property 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 ' respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE—T: ? Transporter 1: FIBER CONTROL INC. 3010 NY 1179.4 518781-3011) ame Ad r~s Te Driver: Registration # NY 480139 AR Date: Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Ma a nt N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: ______________________Date:_______________ Registration #,—' S ignature ate /# Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING,STREET • PORTLAND, CT 06480 PHONE: (800) 272-3867 PERMIT # SW 11302x3 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Date: Signature State / # A kit wledge nt of receipt of materials.

Landfill Name: Phone No: Location: Permi Approximate Volume of Asbestos Received: Discrepancy If An : Received by: Date: ~0 Z' Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000114432