Asbestos disposal documentation form, 265 Broadway, 1999

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 4 8706 WASTE MANAGEMENT GENERATORS • 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 (860) 342-0667 • Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. #. GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. 267 PROPERTY CORP 3010 BURNS AVENUE Address 267 BROADWAY Address WANTAGH city City State NY Zip 11793 NEW"M. NY 1000 ' (516)781 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 YARD Address VOLUME 314 CY Friable, ' Non-Friable p 265.261BROADWAY City Drum ❑ Other ❑ NEW ` 8? K. NY 1 Bag• Wrapped ❑ Phone Number INV #. F1018

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 tc 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 nations' government regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC. ..- BIlRNS-AVENUE WALGH. MY 11733 516481-3000 Tet Telephone # Driver: Cc 4~-- Registration #: NY 1480 139 AR Date: 0611S )2 Si ature State / # A Acknowledgement of receipt of materials.

Transporter 2: Waste N.E.E.T.. Inc.. PO Box 1

Driver: j9/s s..4 Date• state / # ---' Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING,STREET • PORTLAND, CT 06481 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 # N/A Driver: Registration #: Date: Signature State / # of materials.

Landfill Name: Location: ~Sr Approximate Volume of Discrepancy Received by: Certification of receipt of materials covered by this manifest.

`JER. TOR

NYC-WTC 000122398