NYC 9/11 Public Portal Document
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IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-263°• Fax: 718-522-2697 r
MANIFEST
110'16 DATE
Owner's name Wait and Load
7 A'tt1 Dept Of Ent Prk4ect tre Time In
ivt's, ' 't'k \ 1 Time Out
2. Contractor's name and address Drop Date
E",&1 lan to Ku l ban & ti nit
1248 Raiph Avenue ~+
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N E;rc~t~kI~ ln. C' 11236
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WDS phone number
R 3. Waste disposal site (WDS) name, mailing address and physical site location
1131'•i Pil E file Ridge LaIlAtill C-xjXnt 4ien
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O .O. dR .1`l
R Scs.taiid. P!. l r_ t°I"tit!! i IOi"i-L
4. Name and address responsible agency (Local. District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
6.VEH. LI . # /
5. Description of materials C7 6 "/ 7. TOTAL QUANTITY
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE C e5 • 'BAGS
SIZE . Q " 1— , CUBIC YARDS
8. Generator Certification
T 9. ( ;: ; , 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 d are in all respects in proper condition for sport by
A highmtdy according to applicable international government regulations.
S Printed/Typed Name Title Si ure Date M/D/Y)
P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Ilo.
O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215/ TA12"
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DRIVER ,./' s!L(
42ES~e6/Typ9lf Name Title /Si nature 7 Date M/D/Y
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II. DEC PERMIT # NJ-4522
Transporter #2 (Acknowledgement of receipt of materials)
DES..
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A r'
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Printed/Typed Name Title Signature Date (M/D/Y)
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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
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Printed/rypedName Title Signature Date(M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000119727
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