Asbestos disposal form for First Reade Condo, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 48742 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 • Faxi (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 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 1 dRK. NY l001 (516)781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address 109 READE 5TREET VOLUME 112 CV Friable$ Non-Friable ❑ Bag Drum ❑ Wrapped ❑ Other ❑ City NEW YAK. NY 100' 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 61.1.50. 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 i ects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC. 3010 BURNS-AVEHGE WANTA tl. NY 11795 516481-3000 Address Telephone # Driver: Registration #: NY 480139 AR Date: 07124)2 Signature I State / # Acknowledgement of receipt of materials.

7/ Transporter 2: Waste M a ent N.E.E.T. Inc. PO Box 144, Portland CT 06480 1-800-272-3867

Driver: Registration #: ________________________Date: Signature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET • PORTLAND, CT 06480

Received By: 0 `P PHONE: (800) 272-3867 PERMIT # SW 1130223

Certification of receipt of materials covered by this manifest.

Transporter 3: n i J I/i Address Telephone # Driver: istration #: Date: Signature State I # knowledg of receipt of materials.

Landfill Name: No: Location: Approximate Volume of Asbestos Received: '*1/c

Discrepancy If Any: Received by: _ 7-" -O ? Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR

NYC-WTC 000114669