35 Ann Street 104-108 Nassau St. BN# 1001273

NYC 9/11 Public Portal Document

IESI NY CORPORATION 110 5th Street • Brooklyn, N~' 1125 VI Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

11104 DATE z`-

1• Job Site Address Owners name Wait and Load 35 Ana Street Dept (if Emirotmiental Time In N Y New York, N. Y. Protection Time Out

2. C Drop Date &t tfl a as & SO!! 1248 Ralph Avenue o Brooklyn, PITY 11236 E N E R 3. iL Fa WDS phone number

AT P_{3. Box 399 o - _ Scotland, Pa. 17254 PetIn # 100934 R

4. Name and address responsible agency (Local. District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

5. Description of materials 6.VEH. LIC. # 7. TOTAL QUANTITY (RQ) WASTE ASBESTOS 9, NA2212, III TYPE . BAGS SIZE 2-- CUBIC YARDS 8. Generator Certification

T 9. CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R above by per shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A high o , 'ng to applicable international government regulations. N S Printed/Typed Name Title Signature Date (M/D i P 10. Transporter #1 (Acknowledgement of receipt of materiels) DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY)215 JA-462 R T E _ A ri Printed/fyped Name 4 Title Signature e Date M/D/Y 2 //v ? II. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W 1 . T ______________

T Print Name Title Signatb. Date'tM/1)/Y) E 12. Discrepancy indication space

S

T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12

ntedrt'yped Name Title O Signature U .SIILL ___________

Date (M/D

WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000116533