Asbestos disposal form for EPA Region 2, 2002

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48751 WASTE MANAGEMENT GENERATORS EPA Region 2 LOGANO EPA New England 1 Congress Street 290 Broadway, 26th Floor New York, NY 10007-1866 EMERGENCY RESPONSE P.O. Bolt 144 • Portland, CF 06480 (860)342-0667 • Fax:(860)342-4866 Boston, MA 02114-2023 (212) 264-6770 TELEPHONE Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# ~- 1, p ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. Address Address 3010 BURNS AVENUE 10-12 CORTLAND -STREET City WANTAGH NY Zip 11793 city N w YORK, NY State. Zip State (SIM7813000 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container 100 YARD Address 1012 CORTLANI) STREET VOLUME 3 CY Friable Non-Friable ❑ city Drum ❑ Wrapped t Other ❑ l lf YORK. Nfp Bag Phone Number INV #. F10S9 RQ, ASBESTOS, 9, NA2212, PG III 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 property 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/placard are i s in proper condition for transport according to applicable international and national government regulations. AUTHORIZED SIGNATURE Transporter 1: Driver: .f-- Registration #: NY /480139 AR Date: Signature State /# Acknowledgement of receipt of materials.

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Driver: Acknowledgement of receipt of materials. '

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING*STREET • PORTLAND, CT 06480 ,~ • ~ PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: V Certification of receipt of materials covered by this manifest.

Transporter 3: . % i Name Driver. Date: State I# of receipt of materials.

Landfill Name: Location: Approximate Volume of Asbestos Received: Discrepancy If Any: r Received by: 7-2 -&2.. Certification of receipt of materials covered by this manifest.

NYC-WTC 000126323