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

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 4EO 1 S WASTC MANAGEMENT GENERATORS q EPA Region 2 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) 342-0¢67 - Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE Out ofState 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. Address Address 3010 BURNS AVENUE 112 READE STREET City State Zip City WANTAGH State NY Zip 11793 NEW YORK, NY 178180 Phone Number Telephone Number U6Q62 07125J2 Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 Yip Address 112 NAD STREET VOLUME 114 CY Friable' Non-Friable ❑ SN W YORK NZipY city Bag' Drum ❑ Wrapped ❑ Other ❑ Phone Number INV # F1065 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 labeled/placarded, and are in al ects in proper condition for transport according to applicable international and nationa government regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC. --384A•R,IJRNS VEyLtE WANTAGM NY 11733 51 7Ri 1fV1 Name Address Telephone # Driver: Registration #: NY 1420 139 AR Date: 07124)2 Signature State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: 49 9Z ~ ~ _ Date: Si ature State / # Acknowledgement of receipt of materials.

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

Transporter 3:

Driver: Name 1<) \%ç Address Telephone # Registration #: Date: Signature State / # Acknowledgement of receipt of materials.

Landfill e: Phone Nam, X4frf Location: .~ Permits Approximate Volume of Asbestos Received. \fLf CL( Discrepancy If Any: Received by: Date: 7- -p Certification of receipt of materials covered by this manifest.

NYC-WTC 000114745