Asbestos abatement invoice, 198 Broadway, Aug 2002

NYC 9/11 Public Portal Document

IESI.N\cORPORATION • 110:5th Street: NY 11215 • Brooklyn,

Phone: 718-522-2263 • Fax 718-522-2697 MANIFEST

11786 DATE 1 • Job Site Address Owner's name Wait and Load- Of ` &Prth In : ..

New Yak. NI( S. e

Tim

Time

Out

2. Contractor's name and address Drop Date

G 124 hAvt3e 1 ' 11236 .. E N E R 3, Waste disposal site (WDS) name, mailingaddress and physical site location WDS phone number A

O +1 R P.O.E 399 Seettau4.h.17254 4. Name and address responsible agency (Local; District•or EPA Office where notification was sent)

US EPA 290 Broadway, New York t00.07

S. Description of materials 6.VEI. LIC. # P 7. TOTAL QUANTITY • (RQ). WASTE ASBESTOS 9, NA2212, III TYPE " G' 7 BAGS SIZE " ICYARDS. 8. Generator Certification

_________ __________ :A,M/ 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 iii respects in proper condition for tnsport all

A highway according to applicable international government regulations. N. Af •, ,_ S Printedfr Name Title ' Signature Date P 10. ' Transporter #1 (Aeknowledgentent of receipt of matmiatsl Q 'IESI NY CORPO - TION'• 11.0' 5th Street, Brooklyn • DEC Pern,No.. I S :T R '

DRIVER E n Name , T3tle Si Date R 11. Transporter #2 (Acknowledgementof receipt of materials) DEC PERMIT #, w

A

T E Printedrr 12. Name Discrepancy indication space a k aalre Date

S

T 13. Waste dispose site owner or operator Certification of receipt of asbestos materialscovered by this manifest except as noted iii Item;#92' .. • ' E.

•ntedfrypedName Tje Signature • • • Date(M/D/Y)

WHITE:LANDFILL

* GREEN:IESI •

PINK:GENERATOR a • YELLOW:CONTRACTOR

GOLD:JOBS SITE

NYC-WTC 000123200