Invoice for roof work, 121 Fulton Street, July 2002

NYC 9/11 Public Portal Document

IESI NY CORPORATION 110 5th Street • Brooklyn, 11215 N Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST /s

11106 DATE + ____ _.

I. Job Site Address Owners name Wait and Load 121 Fulton Steeet Dept of Environmental Time In N Y New York, N.Y. Protecttcm Time Out

2. C t ors,oat a fBan & SM Drop Date

123g Ralph Avenue G Brooklyn, NY 11236 E N E R 3. WDS phone number A P.O. lBor 399 0T Scotlalnd, Fa 17254 Permit # 100934 R

4. Name and address responsible agency (Local. District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

S. Description of materials 6.VEH. LIC. # 7. TOTAL QUANTITY (RQ) WASTE ASBESTOS 9, NA2212, III TYPE . BAGS SIZE CUBIC YARDS 8. 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 highwa " cc rn to applicable international government regulations. N S PrintedT Name Title Signature Date M 4 P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY R 215 JA-462 T Gl`!`L IIR14EIt Z .k c1 2 E Print yped Name Title ignsture TJ Date(MID/Y) `1 R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #

T P t sod Name S\ -\ Title Signature" Date(Ki/D/Y) E 12. Discrepancy indication space

S I 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

A y C. Cfi ntedlryped Name y Tie Si cure Date (M!D Y)

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

NYC-WTC 000119511