Invoice for asbestos work, 57 Ann Street, November 2002

NYC 9/11 Public Portal Document

IESI NY CORPORA*dN 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 . MANIFEST

11479 1 • Job Site Address Owners name Wait anLoad ~7 Asia .Stret Dept Of E'as'wo Time ~} x5 ~Y . N +I1n, L ~~t Time(JtYt. ',~

w ~.

2. C r t r ram add s Drop Date .3 1248 Av+0t E &off, NY 11236 N E R 3,4j WDS phone number

a •Scotlaaid,Pa 11234 Paml~ # 100934. R

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 material's

(RQ) WASTE ASBES S 9, NA2212, III 6.VEH. LIC. # TYPE 4? 7. TOTAL QUANTITY

CMSICb BAGS CUBICYARDS 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 highway according to applicable international government regulations. N S Printedtl'yped Name Title Signature Date P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Pen nit No. 0 IE Y CORPORATION • 110 5th Street, Brooklyn, NY 11 15 R TA-462 T DRIVER' E Print Name Titic nature Date M/D/V R 11. Transporter #2 (Acknowledgement of receipt of materials) , DEC PERMIT # W

T E Printed/1 12. Name Discrepancy indication space Title ('' St ure Date

.)

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

tLlfi ;•(-;r . Printed'ryped Name Title Signature Date (M/D/Y)

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

NYC-WTC 000119728