111 READE STREET Block: 145 Lot: 16 BIN: 1001586 AKA's:

NYC 9/11 Public Portal Document

E.P.A. AGENCY # 99 48753 CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT GEs ORS EPA Region 2 LOGANO EPA New Encland 290 Broadway, 26th Floor EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 1 Congress Street New York, NY 1 0007-1866 (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(p ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. STAR OF DAVID ASSOC 3010 BURNS AVENUE Address 111 NNE SHEEr Address . WANTAGH city City State NY Zip 11793 iEG YC1 ; t$W 10013 Z!p (516)781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 YARD Address 111READE STREET VOLUME 1/16 CY Friable ~[ Non-Friable ❑ City Bag Drum ❑ Wrapped Other ❑ NEW i`K, NY 100' Phone Number INV #. F1059 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 all respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC. 3010 BU AN GH. NY 11733 516-731-3000 ~ l a ess Telephone # Driver: 1V Registration #: NY 1480 139 AR Date: 0'12 Signature State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: C~ ;Z .— Date: _ i nature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET • PORTLAND, CT 0648 PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: e Address Telephone # Driver: Registration #: Date: ignature State / # Acknowl dgement of receipt of materials.

Landfill Name: Location: Phone No: Permit F2"/ r Approximate Volume of Asbestos Receive Discrepancy If Any: Received by: Date: 7 . .2.je —6~—. Certification of receipt of materials covered by this manifest.

COPY 1 - C;ENE~i,ATCRR

NYC-WTC 000114741