Asbestos disposal documentation form, 154 Chambers St, 2002

NYC 9/11 Public Portal Document

V CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49009 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 06480 TELEPHONE (860) 342-0667 • Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB#S ,p ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number .O.# GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC- CHAMBERS HOUSE PARTNERS LLC Address Address 30'0 BURNS AVENUE 154 CHAMtt~~BERS STREET City WANTAGH State NY Zip 11793 City NEW VRK. NY 10007p tg Phone Number Telephone Number X16)7813000 0626102 07 102 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 11m YARD I Address VOLUME 114 CY Friable% Non-Friable ❑ City State Zi Bag,( Drum ❑ Wrapped ❑ Other ❑ NEW YORK. NY 1000 Phone Number INV t F1059 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 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 P'A!L Transporter 1: Cam.~,~ Name Address Telephone # Driver: 1 lJ/l/l/1 ( Registration #: NY 1480139 AR Date: 0712442 Signature State / # Acknowledgement of receipt of materials.

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

Driver: Registration #: 3 '1// /1! Date: ignature State / # 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 11302x3 Received By: Date: Certification of receipt of materials covered by this manifest.

Transporter 3: Name Address Telephone # Driver: Registration #: Date: Signature State! # Ac owledgement of receipt of materials.

Landfill Name: Phone No: Location: Permit Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Date: 7i - 6 2. Certification of receipt of materials covered by this manifest.

COPY 1 - GENERATOR NYC-WTC 000127105