NYC 9/11 Public Portal Document
IESI N PORATION
110 5th Street• Brooklyn, NY 11215
Phone: 718-522-2263 • Fax: 718-522-2697
MANIFEST
117&1 DATE_______
1, J Owner's name Wait and Load
1I*` Dept Of F,nviro Pretettio
NOW YO* N..Y: Time In.
Time Out
2 Drop Date
I l1p Avenue
G 8 ' N' 11236
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R 3. tt$ispasalaitW) na ,mailing address and ph sical site location WDS phone number
T ;» Spot nd,Pa I7"4 Permit li 10"M
0
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4. Name and address responsible agency (Local, District or EPA Office where notification was sent)
US EPA 290 Broadway, New York 10007
5. Descriptiogofmaterials
6.VEH. LIC. # P 7. 'TOTAL QUANTITY
(RQ) WASTE ASBESTOS 9, NA2212, III TYPE BAGS
SIZE Q
8. Generator Certification
44)_f( ' CUBICYARDS
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.
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1'
Printed/Typed Name Title Signature Date (M/D 14J412
10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No.
R I NY COR ORATION • 1 1 0 5th Street, Brooklyn JA-462
T j'^ }
E DRIVER
rin edlf ame Title Si afore Date M/D/Y
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11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT #.
W
A r3,
SI P edName Title ore Date M/D
E 12. Discrepancy indication space
S ~.
T 13. Waste disposaJ.site owner or operator: Certification of reapipt of asbestos materials covered by this manifest except as noted in item #12
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"Y rift ;Tl. LtLtJc,7r'' .1 7—
Printed/Typed Name Title Signature Date (M/D/Y)
WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR YELLOW:CONTRACTOR • GOLD:JOB SITE
NYC-WTC 000122971
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