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← Document results/DEP Box 47/57 ANN ST BIN# 1001270 57 ANN STREET 1001270, 92/10
Document / 4 pages

Waste manifest form for 57 Ann Street

Machine-extracted title · confidence 90%

Hazardous waste manifest form documenting disposal activities at 57 Ann Street.

NYC-WTC_000119756–000119759

Folder label: “57 ANN ST BIN# 1001270 57 ANN STREET 1001270, 92/10”

Page image
Scanned page image, NYC-WTC_000119757
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document r. ++ - a

•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 ? i .: s 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 E 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. ~r /

S Pntedfl'yp Name Title Sigfure Date P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC O. - °1t' 0 IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11215/ a rAi62 ~`~ j R f ' ~j DRIVER t`~ Name Title ~Si ' lure Date M/D/Y) 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # . IESI NJ 46 ' W ,

S Printed/Typed Name Title Signature Diiá(M/D/Y) T 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 E

1 v f At \ HcdthCiY 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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NYC-WTC_000119757Source: NYC Law Department, mirrored locally

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