179 BROADWAY 1001076, 63/18

NYC 9/11 Public Portal Document

E.P.A. AGENCY NY GENERATORS #99 48722 CT, MA,,RI, VT, NH, ME 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 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#C ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. CEDAR MANAGEMENT 3010 BURNS AVENUE Address 20 VESEY STREET Address WANTAGH NY Zip 11793 city NEW Y$RK, NY 1000''1 City State (516)781 Phone Number Telephone Number GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address 12 Non-Friable ❑ 179 BROADWAY VOLUME CY Friable Ci NEW NY 1001 Bag.. Drum ❑ Wrapped 0 Other ❑ Phone Number .{ ~^ I NV #. F1027

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. 30 NTAGH, NY 11733 516-781-3000 ame Address 1 Telephone# Driver: Registration #: ._._._._._._._._._PII _._._._._._._._. Date: 06125102 Si ature State / # Acknowledgement of receipt of materials.

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

Driver Registration #: P II Date: t?ZG GZ Signature -.-. -• -.-.--.-.... --,~._._._._._.: 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 j Received By: N JI Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Date: Signature State / # Acknowledgement of receipt of materials.

Landfill Name: Phone No:L4 " 47 — ZS?/ ii Location: fl ) 15Ca I/ 2'A_/9 Permit #: /G 2ceI/CT 6t 'J?r 7/ 2

Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Date: ____ 7/0 A Certification of receipt of materials covered by this manifest.

COP'; GENERATOR

NYC-WTC 000122784