NYC 9/11 Public Portal Document
37
NYDEC .1h-371 . NYDCA 483056
Q7
~1 eQsto~ ramportation . 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 Gust #
1. Work Site Name and Mailing Address Owner's Name, Address, Phone Number
j. . . ELA\ 1-.,. ;< ,`: ;..,Al.'r`
\\ iLFL. V. W iO. 1:k.
Contractor's Name, Address Waste Disposal Site
t ;,,y 30{`t t.,I. 1 s, ,.'j_tT- i {..i..
?i..:. :{. ?'. P0 t
NTi 4 ER I I)t tI'.l:, ( Il'1'. W . X`330
Name and Address of Responsible NESHAPS Agency Other 0
U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007
Description of Materials Bags - Cubic s. -
RQ Waste Asbestos, Class 9, NA2212, PGIII O Other pnrns ar Tats - OTH R-
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 tle ignature Date (M/ D )
Transporter I (Acknowledgement of Receipt of Materials)
Telephone No.
Company Name and Address Signature: 631-924-5054
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
fe' 631-924-5050
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Na Q .K. J (ç ate
HAMPTON BAYS, NY 11946
Title: DRIVER €v
Discrepancy Indication Space:
Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Accepted)
:f}I. Telephone No.
>tt:.AD0Wi 11. .. I .3 ; i.?.
Signature:
Printed Name: DateDate
7'Z'..IL
Company Name and Address Title: d 2 '
to
NYC-WTC 000118943
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