NYC 9/11 Public Portal Document
17 &oA D4A'f k3i
, NYDEQ 1A-371 NYDCA 483056
CQ/(Bboekoes d/ /rancsportdion 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 #
f0 2~
1. Work Site N e and Mailing Address Owner's Name, Address, Phone Number
D.E.P.
?._ TRINITY L. 531 .I~.:NC:ION BLVD.
NEW YORK. N. CORONA . N. V
Contractor's Name, Address Waste Di: F4 ~t I L L LAND? I ii..
R: RT. #2. BOX 63
.4-=3 129TH ST :EET BR..Dt:; I't~RT. WV. 2 330
COLLEGE POINT. NY
Name and Address of Responsible NESHAPS Agency Other O
U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials IBags - Cubic Yds. -
O RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other
Drums or Tons -OTHER -
O 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
shipping name and are classified, packed, marked and labeled and are In all respects In proper condition for transport by proper
highway according to
applicable International government regulations.
Printedlryped Name Title Slgnatur Date (M)D/YY)
Transporter 1 (Acknowledgement of Receipt of Materials)
Company Name and Address o Telephone No.
Signature:
ASBESTOS TRANSPORTATION CO., INC. 631-924-5050
P.O. BOX 1044 Printed Name: i so Date.
HAMPTON BAYS, NY 11946
Title: DRIVER
Transporter 2 (Acknowledgement of Receipt of Materials)
Company Name and Address Telephone No.
Signature
ASBESTOS TRANSPORTATION CO., INC. 631-924-5050
P.O. BOX 1044
HAMPTON BAYS, NY 11946
1 Printed Name: Da~~ 7
Title: DRIVER
Discrepancy Indication Space:
''((,~ D7'~ tt(( _ p LL D7~ Waste Disposal S e er o Operat is Cerlifl lion (Receipt of Above Waste Accepted)
M . LANI ILL
Telephone O.
; 304 } S .s2-2 ' 34 Signature:
Printed Name.
Company Name and Address F-ntis.-
('I!
roc
AA P
NYC-WTC 000118021
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