NYC 9/11 Public Portal Document
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NYDEC 1 -371 NYDCA 483056
be~to~ ransporLabon ., 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 #
6
1. Work Site Name and Mailing Address Owner's Name, Address, Phone Number
. ti' . tl' _''" ' K . `_'
Contractor's Name, Address Waste Disposal Site
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P TC .E_\DOW L i\ \;I! l . ... T..
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t-_'` 2 ' T 2. BON 6S
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COLLEGE \T. :'i 3R DC PORT, WV. 16 1 30
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.
Waste Asbestos, Class 9, NA2212, PGIII ❑ Other Drums or Tons - OTH -R -
t Waste White Asbestos, Class 9, UN2S90, 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.
-CL 0~
Printed/Typed Name tie ignature Date (M/ D )
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
ASBESTOS TRANSPORTATION CO., INC.
P.O. BOX 1044 Printed Na
ure.
e (c
~r
Z(~
5 7 631-924-5050
ate
HAMPTON BAYS, NY 11946 77
Title: DRIVER &p
Discrepancy Indication Space:
Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Accepted)
L ND. : LL Telephone No.
Signature:
2 -_i•
_,1
Printed Name:,e,-tJA Date
Company Name and Address Title: S I
7 27 Q 1.
P
NYC-WTC 000118944
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