NYC 9/11 Public Portal Document
IESI NY CORPORATION
110 5th Street • Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
11779
1. Jdbsue
Nay
New Yort, N.Y.
8/13/02
Dept
0E Enyiro Fr
DATE
Wait and Load
Time In:
Time Out
Drop Date
0Z*<0x-
NE KO Adenue
Brooklyn, NY 11236
IEST Pa Blve Ridge Landfili Corporatien
3.
Tadisdoasirel
S) name, mailing address and physical site location
Scotland, Pa 17254
WDS phone number
Permit #100934
HA
W
A
E
S
4.
Name and address responsible agency (Local, District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
S. Description of materials
(RQ) WASTE ASBESTOS 9, NA2212, III
6.VEH. LIC.#
TYPE
SIZE
29676฿a
Closco
7. TOTAL QUANTITY
8.
Generator Certification
ozyE
BAGS
2 CUBICYARDS
1775
9.CONTRACTOR CERTIFICATION: Thereby declare that the contents of this consignment are fully and accutately described
highway according to applicable intermational government regulations.
10.
Transporter #1 (Acknöwledgement of receipt of materials)
IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 1
Paitol
DRIVER:
Printed/ Tf ped Name
Tile
11. Transporter #2 (Acknowledgement of receips of materials)
TESI
JOSUS
Printed/Typed Name
12. Discrepancy indication space
DEC Permit No.
JA-$62
813/020:462
Date (M/DA
DEC PERMIT #
Si5/62
Date (MD/Y)
13.
• Wasté disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12
Kstrna kikırk
Printed/Typed Name
Datskeeper
Signature
KKK
8liceloz
Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC_000122721
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000122721Source: NYC Law Department, mirrored locally