Invoice for roof cleanup at 47 Broadway, June 2002

NYC 9/11 Public Portal Document

AKA y-7 1gDAt>.JAY NYDE 1A-371 NYDCA 483056

CQ(6becsLoQs&/ramp' ortaLion po., Inc. P.O. BOX 1044 TOLL FREE PHONE 631-924-5050 HAMPTON BAYS, N.Y. 11946 1-800-755-OATC FAX 631-924-5085 "EMERGENCY NUMBER"

Waste Manifest # Job # Floor or Location Cust #

1. Work Site N ie and Mailing Address Owner's Name, Address, Phone Number I). E. 1'. ?: RI\I':Y FL- . 5SI" JUNCTION III_V'D. NEW 'N01'K.N. 'r . CORONA N.Y. Contractor's Name, Address Waste D pq (Alt! I I . L L :A ND F I L I.. FT.. #?. ''r 0N 6 FIO ~r FR [DOT-I'OFT. X V. 2(33O : 4 -_20 1 2FT]I :~TF EET CCLLLOE PO! NT NY Name and Address of Responsible NESHAPS Agency Other ❑

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - lCubic Yds. -

❑ RQ Waste Asbestos, Class 9, NA2212, PGIII U Other Drums or Tons - OTHER - U RQ Waste White Asbestos, Class 9, UN2590, PGIII Special Handling Instructions and Additional Information

OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled and are in all respects In proper condition for transport by highway according to - applicable international government regulations.

_________

Tide 1r x Signatur Date (M D/YY) Printed/Typed Name _____

Transporter 1 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address Signature: 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 Printed Name: t SO Date HAMPTON BAYS, NY 11946 Tide: DRIVER ®/t Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Compan Name and Address Signature 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 Printed Name: .W Dal HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal S e er o Operat is Certifi lion (Receipt of Above Waste Accepted) ; L.", LY-A I Li. N U I I I. L Telqphone No. i (? -t ) • , _ `, t. 4 Signature:

[AAA Printed Name: i Company Name and Address Title:

NYC-WTC 000118020