NYC 9/11 Public Portal Document
CT, MA, RI, VT, NH, ME
E.P.A. AGENCY
t NY GENERATORS
#99 48741
WASTE MANAGEMENT
GENERATORS
r/ Region 2
LOGANO EPA New England 290 Broadway, 26th Floor EMERGENCY RESPONSE
P.O. Box 144 • Portland. CT 06480 1 Congress Street New York, NY 10007-1866
(860') 342-0667„• Fax: (840) 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# I 2 (o ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number O.# GENERATOR/BUILDING OWNER
Contractor FIBFR CflPJTROL INC MARVIN STAHL
Address
Address 3010 BURNS AVENUE 105 READE STREET
City State
City WANTAGH State NY Zip 11793 NEW YORK, NY 10013p
Phone Number
Telephone Number (516)781-3000
orrra GENERATING LOCATION
Date Container Del. `__! Date of Pickup
Type of Container 100 YARD Address 105-107
VOLUME I CV Friable' Non-Friable ❑
City State Zip
Bag' Drum ❑ Wrapped ❑ Other ❑ NEW YORK, NY 10013
'' : Phone Number
^ . . N \.2212, PG ifl INV #. F1041
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
tc
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: FIRFR_ 1TRflI_INC_11fi_ A%FNHWNTAH_NV_ii1 _51 -7R1- W11
Name Address Telephone #
Driver: _~, /~~~~ ~ Registration #: NY 480139 AR Date: 07124A32
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste M na ent N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Driver:
Signature
Registration #: ( _________
l~~ ________Date: 7/)
State / #
Acknowledgement of receipt of materials.
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERINGSTREET • PORTLAND, CT 06481
PHONE: (800) 272-3867 PERMIT # SW 1130223
Received By: Date:
Certification of receipt of materials covered by this manifest.
Transporter 3:
Name Address Telephone #
Driver: Registration #: Date:
Sign ure State / #
Ackn ledgement of receipt of materials.
Landfill Name: t Phone No:
Location: Permit
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: Date: 7 - 0~ 2 ~Z
Certification of receipt of materials covered by this manifest.
NYC-WTC 000114607
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