NYC 9/11 Public Portal Document
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IESI NY CORPORATI •
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2163•• Fax: 718-522-2697 •`
MANIFEST
11016 DATE
Owner's name Wait and Load
7
nn Street Dept Of E~tvt .Pre ectiVII Time In
~vew York, N. `1 Time Out
2. Contractor's name and address Drop Date
11 ainin hutzb l t (~!% 71v 2
1248 Ralph Avenue
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N Brookll~-n, tit' t 1230
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R 3. Waste disposal site (WDS) name, mailing address and physical site location WDS phone number
T TEST Pa Elt.Ie Ridge Latidtilt Ccrlvtatl+
0 P.O. Bc,x 399
R Slrotl. ttd. Pa. 17254 Print )- 100934
4. Name and address responsible agency (Local, District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
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5. Description of materials
6.VEH. LI 1 . # l "wi 7. TOTAL QUANTITY
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE C C / BAGS
SIZE t' Q j) Eve—• CUBICYARDS
8. Generator Certification
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T 9. << .. L. < C t 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 nd are in all respects in proper condition for ansport by
A high,* Cording to applicable international
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government regulations. J
./ - :_. ____________________
S Printed/Typed Name Title Sigilure Date (M/D/Y)
O
10. Transporter #1 (Acknowledgement of receipt of materials) DEC etm1
-`4S2•.No. ~t
IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215/ JA
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D ~,' (. -
r Cr /g~~/1 DRIVER
n Name Title /Si nature " Date (M/D/Y)
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11. Transporter #2 (Acknowledgement of receipt of materials) r DEC PERMIT #
IEST NJ-46 2
T Printed/Typed Name Title Signature Date M/D/Y
E 12. Discrepancy indication space
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T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
t' 1.!t I f ~ 17 Z_-
Printed/Typed Name Title Signature Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000119724
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