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
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