NYC 9/11 Public Portal Document
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IESI NY CORPORAñó V
110 5th Street • Brooklyn, NY 11215 •
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Phone: 718-522-2263 • Fax: 718-522-2697 A2
MANIFEST
11320 DATE 1 /
Owner's name Wait and Load
1. J b Site Addt'eSs
! ] Ann S.t'tte€ Dept Of En1i' Pt ecti n
New Yyfk, N. Time Out
2. C rector s name aid adare~s Drop
Ciell, 321!3 3433 `'iL'' L C i f
124 Ralph Avenue ale
E l;onev 61yt1; NY I I J36 . -
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R ~st It g ad tion WDSphone number
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O k .a'*tl3nh#. Pa. 1734
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4. Name and address responsible agency (Local, District or EPA Office where notification was sent)
• ys US EPA 290 Broadway, New York 10007
5. Description of
materials_
(RQ) WASTE ASBESTOS 9, NA2212, III
F 6.VEH. LIC. #
TYPE fi5
(5 /- 7. TOTAL QUANTITY
'BAGS
SIZE • t'i— CUBICYARDS
8. GenemtorCertification o Q 4J
T 9. CONTRACTOR CERTIFICATION: I hereby declare thane contents of this consignment are fully and accutate described
R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition fo by
A highway according to applicable international government regulations.
N Z
S Printed/Typed Name Title Signature Date M/D
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P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC I eimit o. +'
O SI NY CORPORATION • 110 5th Street, Brooklyn, 1 15 1 JA-462
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4ii /jt DRIVER ;. . C. z Z.
Ek Pnn Name Title .Si Date(M/D/Y)
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PE IT #
W
A
T Printed/F 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
E
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nted/Typed Name Tn e ` Signature Date (M/Q/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000119726
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