Bulk Analysis Chain of Custody Form, 92 Chambers Street

NYC 9/11 Public Portal Document Wi E.P.A. AGENCY #99 48707 alae CEMA aT ‘NH, ME NY GENERATORS ~~ EPA Ragion 2 LOGANO . fees aed an Lees pile Urals EMERGENCY RESPONSE 2a eS aes ays TELEPHONE ‘Out of State 1-800-272-3867 (617) 916-1111 #1-800-272-3867, FB# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM ’ Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBERCONTROLING. 000 CROSLYNHALPER __ ‘Address 3010 BURNS AVENUE pa 323 DOUGLAS ROAD City ___WANTAGH State_NY zip 11793 fe CHAPPRGLA, Ny 1058 ‘Phone Number Telephone Number _ ©16)781-3000 = Date Container Del. Date of Pickup GENERATING LOCATION ‘Type'of Container apnvany > VOLUME___34 CY Friabie i” Non-Friable 2] 2 CHAMBERS STREET Bag hg Drum ( tee Other el NEW YORK, NY 1006f mie Be rp Number INV & F018 Tcartify 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 of 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: | hereby dectare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are Classiied, packaged, marked and labeled/placarded, and are in al respects in proper condition fr transport according to applicable interational and national ‘govemment regulations. “ ©) AUTHORIZED SIGNATURE => LRAoA ‘Transporter 1: F18ER CONTROL INC. BWOOURAS AVENUE WANTAGH, NY 11799 46-78-3000 Ze Me ——_~ Taeshare # Driver: Registration #: NY /490 139 AR ate: O6NOH2 ature State /# Acknowledgement of receipt of materials. ‘Transporter 2: Waste Magaagment N.E.E.T., Inc., PO Box 144, Portland, CT 06480 _1-800-272-3867 Driver: LZ Registration: IFS O/SY Ac __ Date: cue OOF Satara ‘Siato/# Acknowledgement of receipt of materials. FO AS I RT DEES cE OR a Dt ROO 5 TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T,, INC. » 203 PICKERING STREET + PORTLAND, CT 0648 PHONE: (800) 272-3867 PERMIT # SW 1130223 Risser By, cc RS ite et Crtiicaton of receipt of materials covered by this manifest ce Transporter 3: ge ‘Name ‘Address | ‘Telephone # Drive; Regtatration a: ata: ‘Signature ‘State /# crowledgeryent of receipi nates. Landfill Name; 2) GAN afenins Gerxt A gL. Prone No: SMOLLL OSE LA Z ff; Location LUA ULC HLS Da pent ¢ 2ODSYL IIS. aed 71h, EE Approximate Volume of Asbestos Received: ey Discrepancy If Any: Received by: ate: G- 2 ee Certification of receipt of materials covered by this manifest. OGPY | - GENERATOR: NYC-WTC_000122125