183 BROADWAY 1001074, 63/16

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48705 WASTE MANAGEMENT • - GENERATORS EPA Region 2 'LOGANO EPA New Englantl • • 290 Broadway, 26th Floor EMERGENCY RESPONSE 1 Congress Street New York, NY 10007-1866 P.O. Box 144 • Portland, CT 06480 TELEPHONE Boston, MA 02114-2023 (212) 264-6770 (860) 342-0667 • Fax: (860) 342-4866 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. ROBERTA SAFDIE Address 183 BROADWAY Address 3010 BURNS AVENUE City City WANTAGH State NY Zip 11793 NEW ?K. NY 1001 Phone Number (516)781-3000 Telephone Number 0512382 2 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address

VOLUME 1 GY Friable,, Non-Friable ❑ City NEW b?IC, NY 1ooth Bag f Drum ❑ Wrapped ❑ Other ❑ Phone Number ( : i INV#: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 defined by 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. 3010 BURNS AVENIIrWA,ITAGH MY 11733 Z)1b-fai~axllu Na Address Telephone # Driver: L Registration #: NY 1420 139 AR Date: 06/19102 nature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste Mana t N.E.E.T., Inc., PO Box 144, Portland, CT 06480 000-272-3867 1--8- Driver: _______________________________________Registration istration #: ~yy15 Y /~~ Date: i ature State / # Acknowledgement of receipt of materials.

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

Transporter 3: Name Address Telephone # Driver: N/A Registration #: Dater Signature State / # AcknowledaemerI,4f recei6t'of materials.

Landfill Name: hone No: Location: //.D`~Vh 1 S14 it Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Certification of receipt of materials covered by this manifest.

- GENERATOR

NYC-WTC 000122998