Asbestos inspection report form, 49 Broadway, July 2002

NYC 9/11 Public Portal Document

NYDEC 1A-371 NYDCA 483056

or beto~ & Xnal"On,spbrLdion O 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 Mapifest # Job # Floor or Location ICust # 1_ _

1. Work Site Name and Mailing Address Ow~er' . Nne, Address, Phone Number 4') HFOADW_1'i BSI ' JL'N(C•TION BLVD. L44' YORK.\. 't CURONA.\.1' .

Contractor's Name, Address Wal ~ L LAND F I L I. TRIi1 R #2, BOA: 6::; 14-20 129TH STREET B;:IDCrEI'OhT. t4'4' 26 O COLLEGE POINT. NV

Name and Address of Responsible NESHAPS Agency Other 0

U.S. EPA REGION 11, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - Cu oYds. -

RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other Drums 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.

,~ ~~ ~- 7 ---- i( Printedlryped Name Title Signature Date (M/D Y) Transporter I (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: Sy4°.vye wj Si~ . Date HAMPTON BAYS, NY 11946 Title: DRIVER Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address Signatur 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 ranted N Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal S ner rator's Certificatio eceipt of Above Waste Accepted) X11 :Ll! X11 T : ;. i .:'\Al F . :• I. Telephone No. Signature:

Printed Name: D to

Company Name and Address Title: u it44 NYC-WTC 000118068