Asbestos abatement invoice, Fiber Control, June 2002

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 4871 2 WASTE MANAGErt _ 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 (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# 6024 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job NumbeFIBER CONTROL INC. P.O. # GENERR I . EIqQL INC Contractor 3010 BURNS AVENUE Address 0210 4TH AVENUE Address WANTAGH NY 11783 City BROQJN. NY 112l ) City 15161781-ate Zip I Phone Number Telephone Number OSf_3102 OC 0 2

Date Container Del. Date of Pickup GENERATING LOCATION 1W YARD Type of Containej11, Address 27 PARK PLACE VOLUME CY Friable• Non-Friable p City YORK. Mp Bag,' Drum ❑ Wrapped ❑ Other ❑ Phone Number

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 FIBER CONTROL INC. 3010 BURNS AVENUE WAN , NY 11759 516-781-3000 Transporter 1: me address ,v , Telaohrnoft_ 859 AL Driver: Registration #: ' Date: Sig ture State /# Acknowledgement of receipt of materials.

Transporter 2: Waste Ma ent N.E.E.T., Inc. PO Box 144, Portland CT 06480 1-800-272-3867

Driver: Registration Date: ~' Signature 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 Received By: _ N/A Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name N/A Address Telephone # Driver: Registration #: Date: Signature State / # Acknowledgeprent~f rc t of materials.

Landfill Name: No: Location: Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: of receipt of materials covered by this manifest.

NYC-WTC 000126503