NYC 9/11 Public Portal Document
WL
WASTE MANAGEMENT -
s
CT, MA, RI, VT, NH, ME
GENERATORS
E.P.A. AGENCY
NY GENERATORS
EPA Region 2
#99 48752
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: (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-55 ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O. # GENERATOR/BUILDING OWNER
Contractor FIBER CONTROL INC. SALIM SAUARE
Address 110 READE STREET
Address 3010 BURNS AVENUE
city
.City WANTAGH State NY Zip 11793 W YORK. N' '
(516)781-3000 Phone Number
Telephone Number
Date Container Del. Date of Pickup GENERATING LOCATION
Type of Container 100 YARD Address 110 READE STREET
VOLUME 1116 CY Friable, ' Non-Friable ❑ city
y YORK. Nip
Bag' Drum ❑ Wrapped ❑ Other ❑ Phone Number
INV #. F1059
3 4-. 1' A22 1 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 b)
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 labeledlplacarded, and are in respects in proper condition for transport according to applicable international and nationa
government regulations.
AUTHORIZED SIGNATURE
Transporter 1: FIBER CONTROL INC. 301 AGH. NY 11733
Name Address Telephone #
Driver: l Registration #: NY 1480139 AR Date: 07f24A2
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste Man, gent N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Driver: istration #: c75' 4VState / # A"-P Date:
nature
Acknowledgement of receipt of materials. ' '
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERINGSTREET • PORTLAND, CT 064E
1 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:
Signatur State / #
c owledgjent of receipt of materials.
Landfill Name: Phone No:
Location: Permit.
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: 7-2t -- O -
Certification of receipt of materials covered by this manifest.
COPY ; - GENERATOR
NYC-WTC 000114693
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