License agreement for debris removal, 49 Broadway, 2002

NYC 9/11 Public Portal Document

NYbEC to-371 NYDCA 483056

rl be~tos d/ramportdion (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 ICust #

1. ork ite N and Mailing Address Owner's Name, Address, Phone Number D. E.P. 25 TRINITY P1. . 5SI - JUNCTION BLVD. Contractor's Name, Address Waste pç S1D : LL LANDF _ RT. 42, BOX 6S TRIO BRIDGEPORT. WV. 2.330 14-2L -29TH STREET 'OLLfE POINT. NV Name and Address of Responsible NESHAPS Agency Other Cl

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

O RQ Waste Asbestos, Class 9, NA2212, PGIII O 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 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 Signature Date D/YY) 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 Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address atu 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 N Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal er or Operator's Ce cation (Receipt of Above Waste Accepted) ~' ?r !t~ : i L L :.. ~N D r ": L1 Telephone No. Signature: ? ' 304)84-' - 2 " U s PrintedNamJ Date

Company Name and Address Title: v v

NYC-WTC 000118078