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← Document results/DEP Box 49/182 BROADWAY 1001102, 65/19 BN# 1001102
Document / 26 pages

Permit application for roof work, 182 Broadway, August 2002

Machine-extracted title · confidence 100%

Application form from Benjamin Kurzban & Son Control Inc. to the DEP regarding contract REM-ROF2 at 182 Broadway.

NYC-WTC_000122946–000122971

Folder label: “182 BROADWAY 1001102, 65/19 BN# 1001102

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Scanned page image, NYC-WTC_000122971
OCR text

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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 E N E 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 R

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. N S 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 R 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 E /

"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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NYC-WTC_000122971Source: NYC Law Department, mirrored locally

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