WTC environmental hazard assessment form, 49 Broadway

NYC 9/11 Public Portal Document

s7 (

NYDEC 1A-371 NYDCA 483056

bestos P5ransporLaLion (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"

WasteAlanlfest # Job # Floor or Location Cust #

1. Work Site Name and Mailing Address ewer'sNape, Address, Phone Number 49 BROADWAY 531 ' JUNCTION BLVD. NEW YORK. \ . Y . CO.ROXA . ti .1' . Contractor's Name, Address Waft t~f! ,fitp L TRIO LAND? : L L RT. -* 2. BOX 6<< 14-20 129Th 'yTRE-ET COLLEGE POINT, NY BSIDG£PORT. tint' 26330

Name and Address of Responsible NESHAPS Agency Other 0

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - ICubicrds. - Q Waste Asbestos, Class 9, NA2212, PGIII 0 Other 'Drtans or Tons -OTHER - ❑ 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 (M/DD YY) Transporter 1 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address Signature ASBESTOS TRANSPORTATION CO., INC. 631-924-5050 J/ P.O. BOX 1044 Printed Name: -~ X1/${,,,4-,- ' ! / i Sera, Date HAMPTON BAYS, NY 11946 l Title: DRIVER Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address Signatu ASBESTOS TRANSPORTATION CO., INC. 631-924-5050 P.O. BOX 1044 rimed N Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal S . er rator's Certificati ceipt of Above Waste Accepted) MEADOW? ILL LANDFILL Telephone No. 1(3O4)S42-2'83 Signature: Printed Name: D to

Company Name and Address Title: u

NYC-WTC 000118094