Asbestos disposal form, 181 Broadway, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGE , , 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, Cr 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# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATORIBUILDING OWNER Contractor FIBER CONTROL INC. 181 BROADWAY ASSOC. 3010 BURNS AVENUE Address 20 VESEY STREET Address WANTAGH NY 11753 City NEW )RK, NY 10 City State Zip 516)781.3000 Phone Number Telephone Number Date of Pickup GENERATING LOCATION Date Container Del. Type of Container 100 YARD Address 3N 191 BROADWAY VOLUME CY Friable' Non-Friable p city NEWi bV K. NY 100th' Bag)( Drum ❑ Wrapped ❑ Other F1 Phone Number INV or 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 aetineopy 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. NY 11733 516-781-3000 Address reie~nong u _ Driver: ration A NY 1480139 AR Date: State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Mana me .E.E.T. Inc. PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: Registration #: AS A Date: . ig ature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET • PORTLAND, CT 0648( N/A PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: Certification of receipt of materials covered by this manifest.

Transporter 3: Name N/A Address Telephone# Driver: Registration #: Date: Signature State / # AeKrtowledaement of re iat of materials.

Landfill Name: M

Location: Approximate Volume of Asbestos 4 CI Discrepancy Received by: Certification of receipt of materials covered by this manifest.

OF I - GENERAro

NYC-WTC 000122920