Air quality and dust composition lab report, 88 Pine Street,

NYC 9/11 Public Portal Document

• IESI NY CORPORATION 110 5th Street • Brooklyn, NY 11215 Q .

Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST r;

Ji DATE

L Job Site Address owner's name Wait and Load 5 I"i t? ` at i ~, t i. =Y tdTi lft f rl :: Time In f ii Time Out ii,'

I 2. Contractor's name and address

I s )'t I( t Drop Date

N E . kv E'(tk V I('t('tt r

R 3. Waste disposal site (WDS) name, mailing address and physical site location WDS phone number A Q p r r~,

4. Name and address responsible agency (Local. District or EPA Office whPe 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 (1( c3 '.' _i SAGS SIZE %: ; CUBIC YARDS 8. Generator Certification

T 9.CONTRACTOR CERTIFICATION: I hereby declarethat the contents of this consignment are fully and accutately described R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A highway according to applicable international government regulations.

S Printed/ Name /V Title _~—~' Si a Date P 10. spotter #I (Acknowledeemeat of te«ipt of maaial:) Transporter j DEC Permit No. 0 IESI NY CORPORATION • 110 5th Street, Brooklyn,~iY 1 - 1 NI____ R > e T d °' DRIVER 4,• ,. C 11 1O E F int Ns a Title ature Date M/D/Y R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #

A S 4 ` Pnntcd/TypedNme Title Sign sre. ' Date(M/D/Y) T E 12. Discrepancy indication space

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

Printed/Typed Name Title Signature Date (M/D/Y)

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

NYC-WTC 000120421