WTC environmental hazard assessment form, 49 Broadway

NYC 9111 Public Portal Document

NYDEC 1A-371 NYDCA 483056 1. be sLos QnsporLaLion ., 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 # 22

1. ork ite N and Mailing' Address Owner's Name, Address, Phone Number • D.E.P. 25 TR XI TY PL.. 531 JUNCTION BLVD. W YORK.Y.Y. rCRVAf Contractor's Name, Address Waste W! P I %. L L A N D RT. *2, BOX 68 TRIO BRIDGEPORT. Wt". 24}330 14-20 -29TH STREET N OLLEOE POINT, Name and Address of Responsible NESHAPS Agency Other D

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - iCublc Yds. - D RQ Waste Asbestos, Class 9, NA2212, PGIII U Other D~ or Tons - OTHER - U 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.

r rn Printed/Typed Name Title Signature Date ( D/YY) Transporter 1 (Acknowledgement of Receipt of Materials) Company Name and Address Telephone No. Signature: 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 JPrinted Name: Date HAMPTON BAYS, NY 11946 Title: DRIVER i° Transporter 2 (Acknowledgement of Receipt of Materials) Company Name and Address Telephone No. natur 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 N Date HAMPTON BAYS, NY 11946 Title: DRIVER Discrepancy Indication Space:

Waste Disposal it r or Operator's catlon (Receipt of Above Waste Accepted) ~i ..l~x tt': i L~ .. L'F i L .. Telephone No. { 30►) S4_'- 3'5 ,x, Signature: Date

A PrintedNamI Company Name and Address Title: S Ak __________ V v

NYC-WTC 000118095