Asbestos disposal and documentation form

NYC 9/11 Public Portal Document

1~ CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49008 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 (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#'-t,fl j 0 ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number P.O. #, GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. WASHINGTON MKT DEVL CORP 3010 BURNS AVENUE Address 148 CHAMBERS STREET Address city NEW OAK. NY 1000P City WANTAGH State NY Zip 11793 (5 781_000 Phone Number Telephone Number tLfThAFL Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address VOLUME 1B CV Friable Non-Friable ❑ city NEW Y&K. NY 1006P Bag A Drum p Wrapped 0 Other 0 Phone Number INV * 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 - Transporter 1: FIBER Telephone # Driver: 'NY 1480139 AR Date: 07124102 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste M,gnag~ment N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867

Driver: Registration #:Ci !Z ,tty Date: Signature State! # Acknowledgement of receipt of materials.

TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERINGSTREET • PORTLAND, CT 06480 •% - PHONE: (800) 272-3867 PERMIT # SW 1130223 Received By: r Certification of receipt of materials covered by this manifest.

Transporter 3: _ 1 Address releph one # Driver: Date: State / # of receipt of materials. Landfill Name: Phone No: Location: Permit/ Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: 7-a" -a-1- Certification of receipt of materials covered by this manifest.

COPY 1- GENERATOR NYC-WTC 000127134