NYC 9/11 Public Portal Document
IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
DATE 7 /''f
I. Job Site Address Owner's name Wait and Load
Ie €~a 'slt € tJ slsittt##J ? tt` , (': 'Time In
Time Out
2. Contractor's name and address Drop Date
egoll►t' fills'
i11 (
tt ttfort
~pqy
Nei ,.v~ 4yy
4 H, f a Y lOOt.3
3. Waste disposal jsite (WDS) name, mailing address and physiicaalsite location WDS phone number
IESI PrA kltlif! Rt jt{ *.
el
p.c.' 134►I j9i?
sr~ tf d< 1'4 t g`Q P rm:i +0 1(34
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. LIC. # 7. TOTAL QUANTITY
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE ' BAGS
SIZE CUBIC YARDS
8. Generator Certification
9.CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described
above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for tr rt by
highway according to applicable international government regulations.
2 i!
Print Name Title Signature Date
10. Transporter #1 (Acknowledgement of receipt of material.) DEC Permit No.
IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 1215 Jg4 NJ 362
Printed/Typed Name
%, L
Tide
____________
Signature Date
Et/ i/o
11. !Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # N I
o~ f
Printed/Typed Name Tttfe Signslure 7 ,bate M/D/Y
12. Discrepancy indication space
13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
Printed/fyped Name Title Signature • Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR - YELLOW:CONTRACTOR • GOLD:7OB SITE
NYC-WTC 000120420
OCR can misread numbers and units. Confirm readings against the page image before using them.