Asbestos transportation manifest, 47 Broadway, Jun 2002

NYC 9/11 Public Portal Document

NYDEC 1A-371 NYDCA 483056

(.po. CQAbckoa, PYransporLdion , 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 Name and Mailing Address Owner's Name, Address, Phone Number D.E.F.

4` BROADWAY 5S1'" JUNCTION BLVD. YEW YO 'K CORONA.N.Y. Contractor's Name, Address Waste Disposal Site fEADo4t' TLL LA\Dr t.L TRIO :4-2'J 1 29TH STREET RT. r2. BOX ($ NY BRIDGEPORT. WV. COLLEGE IOI T Name and Address of Responsible NESHAPS Agency Other ❑

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

❑ RQ Waste Asbestos, Class 9, NA2212, PGIII 0 Other Dnans or Tons - OTHER - 0 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.

Printed/Typed Name Title Slgnatu Date ( Dom) 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: Date HAMPTON BAYS, NY 11946 Title: DRIVER ®~Z Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address igna 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 rin N i Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal Sit r or rs Ce cation (Receipt of Above Waste Accepted) Telephone o. MILADO FILL LA.NDF I LL Signature: I, 3 0 4) S 4 —'2 ? S 4 Printed Name: Date

Company Name and Address Title: f¼A

NYC-WTC 000118040