WTC exterior inspection form for 112-114 Chambers Street

NYC 9/11 Public Portal Document

V CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48739 WASTE•MANAGEMENT GENERATORS EPA Region 2 LOG'ANO 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# %_4 t 5t ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number .0. # I GENERATOR/BUILDING OWNER Contractor FIRER CONTROL INC. SI JIE ME INC 3010 BURNS AVENUE Address 61 BOWERY STREET Address WANTAGH 11793 City NEW fi t. NY 1001 ' City State--Ty—Zip ____ 81'l000 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address 114 CHAP ER3 STREET VOLUME 1116 CY Friable Non-Friable ❑ city NEW16t K. NY 1001hp Bag Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #- F1040 RQ, ASBESTOS, 9, NA2212, PG III 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 labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE Transporter 1: FER CONTROL INC. 90 OURNS NUE ~1 tANTAGH, NY 11793 516421-3000 Name A & Address T Driver. Registration #: NY 480139 AR Date: ____ 2 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Mana me N.E.E.T. Inc. PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: Registration #: t7 . Date: onature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET • PORTLAND, CT 06480 • _ PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Date: Signature State / # A edgement of receipt of materials.

Landfill Name: : PhoneNo8lV ff7/6/ Location: Permit~lR ~~ Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Certification of receipt of materials covered by this manifest.

COPY 1 • GENERATOR NYC-WTC 000121857