NYC 9/11 Public Portal Document
CT, MA, RI, VT, NH, M
E.R.A. AGENCY
+ NY (ENERATORS
#99 49008
WASTE MAriA13EMENT GENERATORS ~. + EPA Region 2
LOGANO Broadway, Floor EMERGENCY RESPONSE
P.O. Box 144 • Po t1arut, cr o6480 E0 n ow~sEnglan • 290 ro a a , 26t
(860) 342-0667 • Pax: (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
F~3# 0 ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O. # GENERATOR/BUILDING OWNER
Contractor FIBER CONTROL INC. WASHINGTON WT DEVL CORP
Address
Address 3010 BURNS AVENUE 148 CHAMBERS STREET
WANTAGH City
City State NY Zip 11793 NEW RK. NY 10othp
(516)781.3000 Phone Number
Telephone Number
uusrs
Date Container Del. Date of Pickup GENERATING LOCATION
Type of Container 100 YARD Address
VOLUME 1!8 CY FriableX Non-Friable Q city
Bag Drum 0 NEW NY 1001'
Wrapped 0 Other Phone Number INV #. F40S9
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 labetedipiacarded, and are in all respects in proper condition for transport according to applicable international and national
government regulations. ...
AUTHORIZED SIGNATURE
Transporter 1:
Driver: ''MY 1480139 AR ate: O7i2'2
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste Manaa1ment N,E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Driver: _
Signature
`— _ Registration #: c ?d//V_ State / #
Date:
Acknowledgement of receipt of materials. '
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET * PORTLAND, CT 06481
•, • ,,,
-
PHONE: (800) 2772-3867 PERMIT # SW 1130223
Received By:
Certification of receipt of materials covered by this manifest.
Transporter 3: _
Driver: #: Date:
State / #
of receipt of materials.
Landfill Name: Phone No:
Location:
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: j .mot I
Certification of receipt of materials covered by this manifest.
COPY 1 - GENERATOR
NYC-WTC 000127130
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