Asbestos abatement invoice, 180 Broadway, Aug 2002

NYC 9/11 Public Portal Document

• I'ESI N'` ICRPORATION 110 5th Street • Brooklyn, NY :11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

11760 DATE 1. J t Owner's nam e ~ o 0~ectio Wait and Load Dept Of Time In Time Out

z. & Drop Date 1248 Rill ph Avenue G &oe1 Iy>l NY 11236 E N E.,

R 3 I, i S) nan mailing address and physical site location WDS phone number •

t is

T 5+cot1aea4,P& 17254 P+erThld #100934 O R 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 ofmaterials 6.VEH. LIC. # 7. TOTAL QUANTITY (RQ) WASTE ASBESTOS 9, NA2212, III TYPE ' BAGS SIZE 3CUBIC YARDS 8. Generator Certification

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 condition for transport by A highway according to applicable international government regulations. N ii~....r S Printed/Typed Name Title Signature Date P 10. Transpor'tei #1 (Acknowledgement of receipt of materials) _ DEC Permit No. O R IE Y CORPORATION • 110 5th Street, Brooklyn, N JA- T DRIVER R t yped me . Title 11. Transporter #2 (Acknowledgement of receipt of materials) i rata Date 'M/D/Y DEC PERMIT W A .. T Print ame Title '> i stare Date )Y) ' E 12. Discrepancy indication space

S

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

Printed/Typed Name Title Signature Date (M/D/Y)

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

NYC-WTC 000122837