57 ANN ST BIN# 1001270 57 ANN STREET 1001270, 92/10

NYC 9/11 Public Portal Document

" • -= IESI NY CORPORA151O 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST e

11 320 DATE 1. Job Site .3 i 1: s= Owner's name Wait and Load

57 Ann Street Dept Of Envy PttJ4tectven ; 4 New N. `1f' Time Out

2. Coractor s name a~dres Drop Date. beflJmni ztn&Stft 1148 Ralph Av 'nu , 17 E t'uklyn;NY 1t36 . r ° . 8 N a .. E ` R . W ti ad $e tion WDS phone number A T 1' 0. Prt7X 39 O St:&"tl lad. Pa. 17254 kP alt # 1O 3 R

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

US EPA 290 Broadway, New York 10007

r 5. Description of materials 6.VEH. LIC. # ~,? 7 7. TOTAL QUANTITY

(RQ) WASTE ASBESTOS 9, NA2212, III TYPE F ' BAGS SIZE # y• fi- j)I YAi 8. Generator Certification "! Cox

T 9. CONTRACTOR C E R T I F I C A T I O `4 . I hereby declare thalthe contents of this consignment are fully and accurate 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.

te , S Printed/I' Name Title .t Signature Date ti P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC ernut o. 0 SI NY CORPORATION • 110 5th Street, Brooklyn, 1 15 { JA-462 f okr if T ' 'I , //,z E. Printevred Name DRIVER Title .~ .

\Sinature (_. Lr Date M/D/Y ZL R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PE IT # W A T PrintediT Name Title Si re Date(M/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 'w L '11k ted/1 yped Name '• Tii1a ;( Signature tcL '1I Date (M/Q/Y) ,

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

NYC-WTC 000119756