NYC 9/11 Public Portal Document
CT, MA, RI, VT, NH, ME .
E.P.A. AGENCY
• NY GENERATORS .
#99 48723
WASTE MANAGEMENT GENERATORS • EPA Region 2
LOGANO EPA New England
1 Congress Street
• 290 Broadway, 26th Floor
New York, NY 10007-1866
EMERGENCY RESPONSE
P.O. Box 144 • Portland, CT 06480 TELEPHONE
(860) 342-0667 • Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770
Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867
FB# (Z,s'"l ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number .O.# GENERATOR/BUILDING OWNER
Contractor FIRFR CONTROL INC STREETREA1_TV
RARCI AY
Address
Address 3010 BURNS AVENUE 1200 UNION TPKE
City State
City WANTAGH State NY Zip 11793 NEW HYDE PARK. NY 11040
Phone Number
Telephone Number (516)781.3000
OL1t202 GENERATING LOCATION
Date Container Del. Date of Pickup 2
Type of Container 100 YARD Address
VOLUME I CV Friable t4 Non-Friable ❑ I aay
Bag Drum ❑ Wrapped ❑ Other ❑ Phone Number
"~" ' """• "' """'
INV #. F11027
I certify the above named material does not contain free liquid as defined by 40 CFR part 260.10 or any applicable state law, is not a hazardous waste as defined,by
40 CFR part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to
NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150.
Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are
classified, packaged, marked and labeted/placarded, and are In all respects in proper condition for transport according to applicable international and national
government regulations. ~---
AUTHORIZED SIGNATURE _~~
Transporter 1: Mr.1t c oli3Rrn INC 3010 su_ y
tsue wj'1 GH. NY 11753_516-781-3000
Name Address Telephone #
Driver: Registration #: NY 1400139 AR Date: 0425102
Signature State! #
Acknowledgement of receipt of materials.
Transporter 2: N.E.E. CT
Date:________
State! #
Acknowledgement of receipt of materials.
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING•STREET' PORTLAND, CT 0648
PHONE: (800) 272-3867 PERMIT # SW 1130223
Received By: ti Date:
Certification of receipt of materials covered by this manifest.
Transporter 3:
Name i eiepnone
Driver: A Date:
Signature State / #
Acknowledgement of receipt of materials.
Landfill Name: ..S Al No: gg-47q -- z '
Location:/ [LOU Pte! ,s"`, 'ermit #
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: C - Date: f2(, /97/4
Certification of receipt of materials covered by this manifest.
NYC-WTC 000119779
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