Asbestos disposal form, 183 Broadway, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 48705 CT, MA, RI, VT, NH, ME NY GENERATORS WASTE MANAGEMENT GENERATORS ' EPA Region 2 LOGANO EPA New England 290 Broadway, 26th Floor EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 1 Congress Street New York, NY 10007-1866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE (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 WANTAGH State NY Zip 11793 city NEW _ NY 1001 (516)78100 Phone Number Telephone Number ° 05f23A2 06120102 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address

VOLUME 1 CV Friable Non-Friable ❑ BROADWAY city g&, NY 1oodf Bag J Drum ❑ Wrapped ❑ Other 1111 Phone Number t 2 INV #. F1018 ` ° r... ;, 1 Phi H

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 A TAGH NY 11733 516-781-3000 Na Address Telephone # Driver: Registration #: NY 1480139 AR Date: 06119A2 nature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste ManaØpt N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867 -- Driver:____________________________________Registration #: 9~7~y`~ Y /~'~-~' Date: ' i ature State / # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERINGSTREET • PORTLAND, CT 06481 PHONE: (800) 272-3867 PERMIT # SW 1130223

Received By: N/A Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: N/A Registration #: Date: Signature State / # Ackn ledge e f rec of materials.

i Phone No: /792 7 Landfill Name: Location: Permit #

Approximate Volume of Asbestos Received: 1 Discrepancy If Any: Date: — ~ G~-- Received by: Certification of receipt of materials covered by this manifest.

NYC-WTC 000123022