Asbestos Disposal Form for 155 Chambers Street, 2002

NYC 9/11 Public Portal Document

E.P.A. AGENCY #99 . . CT, MA, RI, VT, NH, ME NY GENERATORS 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. Box 144 • Portland. CT (16480 (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 Number P.O. # GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. HERBER.LMOSKOWLT-7-.-.-.-.-.-.,_ Address ~ I I 3010 BURNS AVENUE Address NY Zip 11793 City City WANTAGH State (516)781,3000 Phone Number Telephone Number Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container _600 YARD Address VOLUME 1116 CY Friable' Non-Friable ❑ 155 CHA ERS STREET City NEW 3? K. NY 1 Bag. Drum 0 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 iq II respects in proper condition for transport according to applicable international and national'''.. government regulations. AUTHORIZED SIGNATURE Transporter 1: FIBER CONTROL INC. 3010 BUM AVENUE WAN lkC11, NY 11793 516-781-3000 ame Address Telephone # Driver: Registration #: NY 1151859 AL Date: 06/19102 nature State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: ,9~~/S~" t' 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 N/A Received By: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Sig ' e State/ft

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

J

NYC-WTC 000127077