License agreement for exterior cleanup, 104 Reade Street

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48740 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 • Rortland, 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# ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 104 108 READE STASSOC Address Address 3010 BURNS AVENUE 104 READE ST WANTAGH NY Zip 11793 City NEW %RK. NY 1004P City State (516")781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 YARD Address 104 READE STREET VOLUME 1r2 CY Friable Non-Friable ❑ City Drum ❑ NEW NY 100' BagX Wrapped ❑ Other ❑ Phone Number INV # F1041 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 Transporter 1: Address Telephone # Driver: ration #: NY 480 130 AR Date: 07á24A2 Signature State / # Acknowledgement of receipt of materials.

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

Driver: Registration # _ y ______~~i~~ Date: ~~✓ ~~ Signature State I# Acknowledgement of receipt of materials.

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

Transporter 3: Name Address Telephone /f Driver: Registration #: Date: Signature State / # kno1dgement of receipt of materials.

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

COPY 1 - GENERATOR NYC-WTC 000114573