Asbestos inspection form for 96 Chambers Street, DEP Box 49

NYC 9/11 Public Portal Document

CT, MA, R1, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48710 WASTE MANAGEMENT ~rrw-^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 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# 6O24 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number O.# GENERATOR/BUILDING OWNER Contractor HERBERT MOSKOWITZ Address ------------------- -------------------- 3010 BURNS AVENUE Address City WANTAGH State NY Zip 11793 city PII Phone Number Telephone Number (516)781-3000 05123A2 06120102 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address VOLUME 1116 CY Friable, ' Non-Friable ❑ city Drum ❑ Wrapped ❑ Other ❑ NEW YORK. NY 100011 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 G Transporter 1: Address Telephone # Driver: istration #: NY 1151859 AL Date: 06119A2 State / # Acknowledgement of receipt of materials.

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

Driver: ration #: Date: State / # (1 `~ 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 0 Driver: N/A Registration #: Date: Signature State / # of ra ipt of materials.

Landfill Name: No: Location: rmit Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: --2/-d Certification of receipt of materials covered by this manifest.

NYC-WTC OOO122192