Document header, 144 Chambers Street, 2002

NYC 9/11 Public Portal Document

CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49006 WASTE MANAGEMENT GENERATORS 4 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# :.} ~p ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number GENERATOR/BUILDING OWNER Contractor FIBER CONTROL INC. HERBERT MOSKOWITZ 3010 BURNS AVENUE Address 70 LAFAYETTE STREET Address WANTAGH NY Zip 11793 City NEW %RK, NY 10(0h" City State (516)781.3000 Phone Number Telephone Number -- Date Container Del. Date of Pickup GENERATING LOCATION

Type of Container 100 YARD Address 144 CHAI ER5 STREET VOLUME 114 CY Friable' Non-Friable ❑ City NEW NY 100& Bag ' Drum ❑ Wrapped ❑ Other ❑ Phone Number INV #. F1059

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 CONTROL IN Name Address Telephone # Driver: istration #: NY 1480139 AR Date: 07r24A2 Signature State / # Acknowledgement of receipt of materials.

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

Driver: n #: ~/ / ~/~o_Date: State / # Acknowledgement of receipt of materials.

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

Transporter 3: Address Telephone # Driver: ration #: Date: Signature State / # of receipt of materials.

Landfill Name: Location: Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: Certification of receipt of materials covered by this manifest.

NYC-WTC 000127284