Asbestos inspection form for 96 Chambers Street, DEP Box 49

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 48710 CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT r.^—ENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Box l44 - 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# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number .0. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. HERBERT MOSKOWITZ Address Address 3010 BURNS AVENUE 70 LAFAYETTE STREET City City WANTAGH State NY Zip 11793 NEW V8 iK, NY 1001 Phone Number (516)781-3000 Telephone Number 05123A2 06rZ0 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address VOLUME 1116 CY Friable ' Non-Friable El city Drum ❑ Wrapped ❑ Other ❑ NEW YORK. NY 1000 Bag 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: FIBER CONTROL INC. 11fl BU i IiUEWfr1flItH WV 117 1 7l - J1 me Address Telephone # Driver: Registration #: NY 1151 859 AL Date: 06119!02 Sig azure State /# Acknowledgement of receipt of materials.

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

Driver: Registration #: Date: 1 -~ nature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING STREET • PORTLAND, CT 0648C PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: N/A Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Nom, Registration #: Date: Signature State / # Acknow dge nt of ipt of materials.

Landfill Name: - Phone No: Location: Permit # Approximate Volume of Asbestos Received: 1/16 CY Discrepancy If Any: Received by: Date: 2% d Certification of receipt of materials covered by this manifest.

NYC-WTC 000122192