Asbestos disposal form for Logano, July 2002

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48752 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 • Portland, 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# ' 1 55( , ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number .0. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. SALIM SAUARE Address 110 READE STREET Address 3010 BURNS AVENUE WANTAGH NY Zip 11793 City W YORK• Nf'P City State (516)781x0 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container Address 110 READE STREET -

VOLUME 1116 CV Friable Non-Friable ❑ v City p Bag Drum ❑ Wrapped ❑ Other ❑ YORK. Phone Number INV # F1059 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 respects in proper condition for transport according to applicable international and national government regulations. ~ ~ t — AUTHORIZED SIGNATUR Transporter 1: FIBER CONTROL INC. 301 AGH. NY 1173s 516-781-3000 Name Address Telephone # Driver: Registration #: NY 1480139 AR Date: 0712442 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Man4geynt N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: #: d~~~~ /~ Date: State /# Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 06480 t^ 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 owledge nt of receipt of materials.

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

COPY 1 - GENERATOR NYC-WTC 000114706