Waste manifest for asbestos disposal, 182 Broadway, 2002

NYC 9/11 Public Portal Document

IESI NYtthPORATION ' 110 5th Street • Brooklyn, •NY 11215 Phone: 718-522-2263. Fax: 718-522-2697 . MANIFEST

: 1' 761 DATE 1. J d Load .

Y , Y. Time In Time Out

Drop Date G 2 1 N .1123Qi E N ,a E R : 3. i i ) mailing and p iced site oration WDS phone number A T ~ ,Pa 17254 0100934 O R

4. Name and address responsible agency (Local, District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10009:

S. Descriptionofniaterials 7: TOTAL QUAN?`IT,Y (RQ) WASTE ASBESTOS 9, NA2212, III TYPE BAGS' SIZE C:UBICYARDS 8. Generator Certification

T 9.CONTRACTOR CERTIFICATION: I hereby declare that. the contents of this consignment are fully and -accutatelyr 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 Printedfr Name _. : rtte Si stare Date P O i0. TT8I1spOft~1` #1 (Acknowledganent of receipt of DEC Permit No. R NY CO ORATION • .1 is 5th Street, Rrookly JA=462 T

S C4t n DRIVER E a T#te Si pate R

W A 11. Transporter #2 (Acknowledgement of receipt of materials) S

,f DEC PERMIT' #.

S T E Prtn 12. `Name Discrepancy indication space Title ... ' &_ SIL S S

T 13. Waste disposalsite owner or operator. Certification of reO ipt of asbestos materials covered by this manifest except as noted in item #12 E

Printed/Typed Name Title Signature' Date (M/DIY)

WffiTE:LANDFILL • GREENJESI • PINK GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000122986