NYC 9/11 Public Portal Document
E.P.A. AGENCY #99 48742
W .V CT, MA, RI, VT, NH, ME NY GENERATORS
WASTE MANAGEMENT GENERATORS
EPA Region 2
LOGANO EPA New England 290 Broadway, 26th Floor • EMERGENCY RESPONSE
P.O. Box 1,44 • Portland, CT 06480 1 Congress Street New York, NY 10007-1866
'(860) 342-0667 • Fan; (860) 3424866 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. FIRST READE CONDO
3010 BURNS AVENUE Address 109 READE STREET
Address
City WANTAGH State NY Zip 11793 City NEW 3RK. NY 1001 P
(516)781-3000 Phone Number
Telephone Number
Date Container Del. Date of Pickup GENERATING LOCATION
Type of Container. 100 YARD Address 109 READE STREET
VOLUME 11 CV Friable Non-Friable ❑ City
NEW ~1(, NY 100
Bag Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #. F1041
-i j
` .ET OS, 9 NA22 12 . P( ill
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 ects in proper condition for transport according to applicable international and national
government regulations.
AUTHORIZED SIGNATURE
Transporter 1: FIBER CONTROL INC. 3010 BURN E WAN1
WANT H. NY 11733 516-781 000
Name Address Telephone #
Driver: V Registration #: NY 420 139 AR Date: 07124)02
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste M a ent N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Driver: Registration #: ~/ ~i~l ~-P Date: 7 h
Signature State / #
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: I Date:
Certification of receipt of materials covered by this manifest.
Transporter 3: '
Name Address Telephone #
Driver: Registration #: Date:
Signature t State / #
, knowledgemgnt of receipt of materials.
Landfill Name: e No:
Location:
Approximate Volume of Asbestos Received:
Discrepancy If Any:
~"
Received by: / ouk,-4 _ Date: 7 —aU 'O;.-
Certification of receipt of materials covered by this manifest.
COF Y , - GENE-1ATOP
NYC-WTC 000114653
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