Asbestos Disposal Form for 156 Chambers Street, 2002

NYC 9/11 Public Portal Document

CT, MA, Rl, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 48713 MANAGEMENT GENERATORS WASTTEE EPA Region 2 LOGANO EPA New England 290 Broadway, 26th Floor EMERGENCY RESPONSE P.O. Box 144 • Portland, CT 06480 I Congress Street New York, NY 10007-1866 (860)342-0667 • Fax:(860)3424866 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 Number P.O. # GENERATORIBUILDING OWNER Contractor FAR CONTROL INC. HERBERT MOSKOMfilZ Address Address 3010 BURNS AVENUE City City WANTAGH State Zip 11793 (518)781.3000 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION Type of Container it1D YARD I Address VOLUME 1118 _ CV Friabie.W Non-Friable F1 ~-~ • •, ,~ ~ it Bag, " Drum ❑ Wrapped ❑ Other ❑

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 1~1-u 1 `~ Transporter 1: Driver: LSA--`, Il. ' 4A L& y -" Registration #: NY 1151 859 AL Date: nature State! # Acknowledgement of receipt of materials.

Transporter 2: Waste Man nt N.E.E.T. Inc, PO Box 144 Portland CT 06480 ..•--.,...~~ .~ +_Registration #: Driver: j '?,5&' 4' Date: ianature State!~# — V Acknowledgement of receipt of materials. `

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET • PORTLAND, CT 0648 PHONE: (800) 272.3887 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! # Ac)'iowled ment of eipt of materials.

Landfill Name: Phone No:

Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Kla I 1 Certification of materials covered by this manifest.

•OPY i - GENERATOR

NYC-WTC 000127036