Bulk Analysis Chain of Custody Form, 92 Chambers Street

NYC 9/11 Public Portal Document WM WASTE MANAGEMENT LOGANO P.O. Box 144 • Portland, CT 06480 (860) 342-0667 • Fax: (860) 342-4866 Out of State 1-800-272-3867 CT. MA, RI, VT, NH, ME GENERATORS EPA New England 1 Congress Street Boston, MA 02114-2023 (617) 918-1111 E.P.A. AGENCY NY GENERATORS EPA Region 2 290 Broadway, 26th Floor New York, NY 10007-1866 (212) 264-6770 #99 48707 EMERGENCY RESPONSE TELEPHONE #1-800-272-3867 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number _P.O.# Contractor FIBER CONTROL INC. Address Address 3010 BURNS AVENUE City WANTAGH State NY ZiP City 11793 Telephone Number (516)781-3000 Phone Number Date Container Del. 03/23102 _Date of Pickup- 03/2002 Type of Container 100 YARD VOLUME 344 CY Bag X Drum E GENERATOR/BUILDING OWNER ROSLYN HALPER GENERATING LOCATION Friable X Wrapped B Non-Friable D Other G Address City Phone Number MA221 INV # F1018 I certify the above namedmaterial does not contain free liquid as defined by 40 CFR part 260.10or 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: Ihereby 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 govemment regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC Driver: Antкonu 3010 BURMS AVEMUE WANTAGH, NY 11799 Address Registration#: NY 1 480 139 AR signature State/ # Acknowledgement of receipt of materials. Transporter 2: Waste Mapaggment N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867 Driver: Signatur Registration #: 09301544 State / # Acknowledgement of receipt of materials. 516-781-3000 Telephone # Date: - 06/1902 Date: 6l2 voг TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET• PORTLAND, CT 0648 PHONE: (800) 272-3867 PERMIT# SW 1130023 Received By: N/A Date: Certification of receipt of materials covered by this manifest. Transporter 3: Name Driver: Signature N/A Address Telephone# Registration #: Date: State /# Acknowledgement of receipyoPnaterials. allu _Phone No: 814479,253 Permit #.0075/k Пров KedZu Location: Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: ahae 3/4 €Y Date: Certification of receipt of materials covered by this manifest. 6-21-02 COPY T• GENERATOR NYC-WTC_000122125