Asbestos waste manifest for 204 Broadway, August 2002

NYC 9/11 Public Portal Document IESINY CORPORATION 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST 11784 DATE 813/02 A T 1. Job Site Address 204 Broad vay New Yor, NV. Owner'sname Dept Of Enviro Protection Wait and Load Time In Time Out 2. Contractor's namé and address Benjaвsin Kuezb met Son 1248 Ralph Avense Brooklyn, NY 11236 Drop Date Waste disposal site (WDS) name, mailing address and physical șite location WDS phone number - IEST Pa Blie Ridge Landäll Corporation BO. Box 399 Scotland, Pa 17254 Permit #100934 4. Hame and address responsible agency (Local, District or EPA Office where notification was sent) US EPA 290 Broadway, New York.10007 5. Description of materials (RQ) WASTE ASBESTOS 9, NA2212, III 8. Generator Certification 6.VEH, LIC.# 29696 (A TYPE elose) .SIZE 40 6ox 4024 7. TOTAL QUANTITY BAGS S CUBICYARDS Sk 11675 9.CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by highway according to applicable international government régulations. Printed/Typed Name Title Signature 10: Transporter #1 (Acknowledgemens.of receipt of materials) JESINY CORPORATION • 110 5th Street, Brooklyn, NYJ Tachik .:DRIVER Finted/Typed Name Title hlb Camя 11. Transporter #2 (Acknowiedgement of receipt of materials) Date (M/D/Y) 8/13/62 DEC Permit No. NZA67 Date (M/DY) 8|05/2 DEC PERMIT# IESI 2SLK Printed/Typed Name 12. Discresancy indication space 8/15/02 ML40 Title Date (M/D/Y) 13. Waste disposal site owner oi operator: Certification of receipt of asbestos materials covered by this manifest except aș noted in item #12 alackithik Printed/Typed Name Sattkupir Kкк 8/16/02 Signature Date (M/D/Y) WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR •GOLD:JOB SITE NYC-WTC_000123306