Asbestos inspection report header, 19 Park Place

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49015 WASTS 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)342-0667 • Fax:(860)342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 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. LEE TAI ENTERPRISES USA LTD Address 19 PARK PLACE Address BURNS AVENUE City City WANTAGH State NY p 11193 YORK,Nfp Phone Number Telephone Number_________________________________ Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD VOLUME 's CV Friabiej Non-Friable ❑ City YORK. If{Tp Bag Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #. F1 065 Rte, 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. AUTHORIZED SIGNATURE__________________________________________ Transporter 1: Name Address Telephone # Driver. Registration #t MY1480 135 AR Date: 07J2A~2 Signature State I# Acknowledgement of receipt of materials.

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

Driver. Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING'STREET • PORTLAND, CT 06480 a - •_— PHONE: (800) 272-3867 PERMR # SW 11302M8 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver Registration #: Date: Signature State / # AcI pwIedgernent of receipt of materials.

Landfill Name: Phone No: Location: Permitir` 7 Approximate Volume of Asbestos Received: Discrepancy If Any: ,_, Received by: ~ 7- Z4 'OZ... Certification of receipt of materials covered by this manffest.

COPY 1- GENERATOR NYC-WTC 000115975