NYC 9/11 Public Portal Document
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IESI NY ORPORATION
110 5th Street "Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
11494 DATE I/E
I _ Owner's name Wait and Load
I. h S,,
5 Dept Of Enviro Protect s3bne In
New Work, N Y Time Out
2. C Drop Date
~ a~ rlt1 + i c
L48 Ri h Avenue
G Btookl n, N' 11.146
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R 3. iZ I' a d {i dlbt$tion WDS phone number
A P 0 BOX X99
o ScktImid. Pa t i, '3 Permit * 10093.1
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4. Name and address responsible agency (Local, District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
5. Description of materials
6.VEH. LIC. # 7. TOTAL QUANTITY
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE f_ i- (~ ' BAGS
SIZE _ , '?/ ~. ~. CUBIC YARDS
^w_.
8. f Generator Certification
T 9. C :) + t ;: ..i : . n. + F ,.:i [ E ! is .; F i { % I hereby declare that the contents of this consignment are fully and accutately described
R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by
A highway according to applicable international government regulations.
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S Printed/ Name Title Si nattlfe Date M
P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No.
O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462
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T " DRIVERS - '~ ~G . 1
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E Printed/fypedName Title Signature ifc Date M/D/Y "?
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #
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S Printed/Typed Name Title ~rSi nature Date (M/DIY)
E 12. Discrepancy indication space
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T 3. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
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Printed/Typed Name Title
P ) / k1A/
Signature
7/ / 2
Date (M/D/X)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000119060
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