EPA Generator Waste Manifest, Sept 2001

NYC 9/11 Public Portal Document

CT, MA, RI, VT. NH, ME E.P.A. AGENCY NY GENERATORS #99 48711 WASTE MANAGEMENT GENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMER•3ENCY 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 #1-80C-272-3867

FB# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. HERBERT MOSKOWITZ Address 70 LAFAYETTE STREET AVENUE Address 3010 BURNS City City WANTAGH State NY Zip 11793 NEW V~? K• NY 1001 (516)781_000 Phone Number Telephone Number Date of Pickup GENERATING LOCATION Date Container Del. Type of Container 100 YARD Address VOLUME 1116 CV Friable Non-Friable ❑ city NEW NY 1 Bags Drum ❑ Wrapped ❑ Other ❑ Phone Number

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:

Driver: Lk_ k1'_1\ (jZT &. Registration #: NYI151859 AL Date: 06119102 c. ati ira State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: _______________________Date: , , . ignature State / # Acknowledgement of receipt of materials.

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

Transporter 3: Name Address Telephone # Driver: N/A Registration #: Date: Signature State / # 6eknowledgemtt of receipt of materials.

Discrepancy If Any: Received by: Date: !~ 2 I1 o Certification of receipt of materials covered by this manifest.

NYC-WTC 000122030