NYC 9/11 Public Portal Document
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•a IESI NY CORPORATI i ...-~ -
110 5th Street • Brooklyn, NY 11215 °
Phone: 718-522-2X636• Fax: 718-522-2697 ►f''
MANIFEST
11016 DATE
. Owner's name Wait and.Load
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7 nu Sh'i'er Dept Of E r Ptcf edit fl Time In •
New York, N. Time Otis
I 2. Contractor's name and address Drop Date,
Eeufm to Kunban .fit Sofa
G 1248 Ralph Avenue 4~t. ci
N Fr'truktyct, N 1123i6
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R 3. Waste disposal site (WDS) name, mailing address and physical site location WDS phone number
T IESI Pa. Blue Ridge L iMit CamIxinit t
0 P.O. Box :399
R Scott td. P. 17254 Permit 0 1OO)J4
4. Name and address responsible agency (Local, District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
S. Description of materials 6.VEH. LI t . # '/ 7. TOTAL QUANTITY
2-16t6
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE C5 BAGS
SIZE Q ~- , CUBICYARDS
8. Generator Certification
T 9. . < ;, . <. t. E t <. t' I i i . • ' . 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 rt by
A higl77tording to applicable international government regulations.
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S Pntedfl'yp Name Title Sigfure Date
P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC O. -
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0 IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215/ a rAi62 ~`~ j
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' ~j DRIVER t`~
Name Title ~Si ' lure Date M/D/Y)
11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # .
IESI NJ 46 '
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S Printed/Typed Name Title Signature Diiá(M/D/Y)
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E 12. Discrepancy indication space
S , a...
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/Typed Name Title Signature Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000119757
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