NYC 9/11 Public Portal Document
CT, MA, RI, VT, NH, ME
E.P.A. AGENCY
NY GENERATORS
isI
WASTE MANAGEMENT GENERATORS
EPA Region 2
LOGANO EPA New England 290 Broadway, 26th Floor EMERGENCY RESPONSE
P.O. Box 144 • Portland, Cr 06480 1 Congress Street New York, NY 10007-1866
(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
s ~
FB# '.f~~~p ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O. # GENERATOR/BUILDING OWNER
Contractor FIBER CONTROL INC. PLAHGER AND CROWL ASSOC
Address
Address 301Q BURNS AVENUE 157 HUDSON STREET
City WANTAGH State NY Zip 11793 CY NEW %Flit. NY ioo?dP
(5 781.3000 Phone Number
Telephone Number
Date Container Del. Date of Pickup GENERATING LOCATION
Type of Container 100 YARD Address
VOLUME 1A CV Friable Non-Friable ❑ city
NEW fi t. NY 100 '
BagX Drum ❑ Wrapped ❑ Other ❑ Phone Number *
INV F
RO, 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 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 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 CONTROL INC. ANTAGH• NY 11795 510-781-3000
ress Teleohone
Driver Registration # NY1480139 AR Date: 07Q4A2
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste M ge nt N.E.E.T. Inc. PO Box 144, Portland, CT 06480 1-800-272-3867
Driver: Registration # tom_ /~ r/ I"t9 Date:
Signature state / #
Acknowledgement of receipt of materials.
TEMPORARY STORAGE / TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T., INC. • 203 PICKERING-STREET • PORTLAND, CT 06480
a . 1 ,, PHONE: (800) 272-3867 PERMIT # SW1130223
Received By:
1 Certification of receipt of materials covered by this manifest.
Transporter 3: k \ I ,,-
Driver Date:
State I#
of receipt of materials.
Landfill N No:
Location:
Approximate Volume of Asbestos
Discrepancy If Any:
Received by:
Certification of receipt of materials covered by this manifest.
COPY 1- GENERATOR
NYC-WTC 000127261
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