Asbestos abatement invoice, 176 Broadway, Aug 2002

NYC 9/11 Public Portal Document

IESI NYt11RPORATION 110 5th Street Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST +~

11779 DATE %/i 3/L-

I.'. ii7óBi ay C f- EltVilro P Wait and Load - ecti xr,~,,,- r t~ • New Y N. :E . Time In Time Out

I 2. C a d )ddk Drop Date

I'Q l'l 11236 G

E • _ IE& Pa Blue Ridge Ltll tc ll Corpwatioal R . 3. t S) name, mailing address and physical site location WDS phone number

AT SCwtla~ Pt 172 P` l # l 00934 O R

4. Name and address responsible agency (Local, District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

5. Description of materials 6.VEH. LIC. # P 1 7. TOTAL QUANTITY

(RQ) WASTE ASBESTOS 9, NA2212,'III TYPE BAGS SIZE CUBICYARDS 8. Generator Certification t

T. 9. CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condi ' n for transport by A highway according to applicable international government regulations. N: $ Printed/Typed Name Title Signature Date M/D/Y K P 10. Transporter #I (Acknowledgement of receipt of materials) - - DEC P _ •t No. C IESI NY CORP RATION •. 110 5th Street, Brooklyn, NY l R T ' ,~ DRIVER E Mnted/F Name Fide ig n Date M/D R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W

T E Printed/r 12. Name Discrepancy indication space Tit a acute Date.(MIDIY)

S

T 13. Waste disposaJ. site owner or operator: Certification of receipt of.asbestos materials coveted by this manifest except as noted in item #12 E

_ Printed/Typed Name Tide Signature Date (M/D/Y)

WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000122687