Asbestos disposal form, Fiber Control Inc., July 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY CT, MA, RI, VT, NH, ME NY GENERATORS WAST^ 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 TELEPHONE (860)342-0§67 • Fax:(860)342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 1-800-272-3867 a (617) 918-1111 #1-800-272-3867

FB# ~?rj 6(,p ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. A 3010 BURNS AVENUE Address 112 READE STREET City state Zip City WANTAGH NY ip 11793 NEW YORK, NY Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container uv YARD Address VOLU E 114 CV Friable' Non-Friable ❑ City State Zlo Bag Drum ❑ Wrapped ❑ Other ❑ NEW YORK. NY Phone Number RQ, ASBESTOS, 9, NA2212, PG III 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 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 al ects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE Transporter 1: iii ER CtlNTRoL IIiC- NUE w,&NTAGH, NY ittss 54s_71. Name Addn3ss p Telephone # Driver: Registration #: NY 1480139 AR Date: 07124102 Signature State I# 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 #: ® ______________________Date: Si ature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 06480 - . • -,._ PHONE: (800) 272-3867 PERMIT #5W 1130223 Received By: Certification of receipt of materials covered by this manifest.

Transporter 3: Driver: Name 1'1 l•1 4 Address Registration #. Telephone#

Signature State I# of receipt of materials.

Landfill Name: ' ° . Location: Approximate Volume of Asbestos Discrepancy If Any: Received by: 7-21e -02-- Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000114796