Asbestos waste manifest, 47 Ann Street, June 2002

NYC 9/11 Public Portal Document

IESI NY CORPORATION 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST 77' 11248 DATE I. Job Site Address Owners name Wait and Load 47 An Street Dept Of EnAroomemtal Time In New York, N.Y. Protection Time Out t~

2. c cJ Ma~4edfd an & Drop Date

124$ Ralph Avenue c Brooklyn, NY 11236 E N E R 3. a dAkdctiti tion WDS phone number

A Y.O. Box 399 0 Scotland, Pa 17254 Permt # 100934 R a

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, H TYPE "BAGS SIZE CUBIC YARDS B. Generator Certification

T 9. CONTRACTOR CERTIFICATION: 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 rnment regulations. j /ree '' / N ( / / G S Printed-Typed Name TitlE Signature pate M/D — P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215 JA-462 R

Printed/ryped Name Title g1W4 Date M/D/Y 11. Transporter #2 (Acknowledgement of receipt of materials) fl fT DEC PERMIT # W

$ 1 S l ,I, Printed/Typed Name Title Signati,e. Date M/D/Y E 12. Discrepancy indication space

S

T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12 E

1 '` a/ 'Printed/Typed Name Title Signature Date (M/D/Y)

WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000119475