NYC 9/11 Public Portal Document
CT, MA, RI, VT, NH, ME
E.P.A. AGENCY
NY GENERATORS
#99 49007
WASTE MANAGEMENT -F JOBS ,
Et'ARegion 2
LOGANO EPA New'England 290 Broadway, 26th Floor EMERGENCY RESPONSE
'P.O. Box 144 • Portland, CT 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
FB# 4 ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O. # GENERATOR/BUILDING OWNER
Contractor FIBER CONTROL INC. 145 CHAMBERS STREET CORP
Address
Address 3010 BURNS AVENUE NEW WW, NY 10007
City WANTAGH State NY Zip 11793 city State Zip
(516)781~3000 Phone Number
Telephone Number
06I262 07I252
Date Container Del. Date of Pickup GENERATING LOCATION
Type of Container 100 YARD
Address
VOLUME 114 CY Friable Non-Friable ❑ City
Bag ' Drum ❑ Wrapped ❑ Other ❑ NEW YbhK. NY 10007
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__________________________________________
Transporter1: FIBER CONTROL INC. 1i AL 1&IIF WTAGH.NY 11733 516-7813000
Name Address Telephone #
Driver: Registration #: NY 1420 139 AR Date: 07124A2
Signature State / #
Acknowledgement of receipt of materials.
Transporter 2: Waste nar1 ent N.E.E.T., Inc., PO Box 144, Portland, CT 06480 1-800-272-3867
Driver: Registration #: -~-. 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
PHONE: (800) 272-3867 PERMIT # SW 1130223
Received By: Date:
Certification of receipt of materials covered by this manifest.
Transporter 3:
Name Address Telephone #
Driver: Registration #: Date:
Signature State / #
Acknowledgement of receipt of materials.
Landfill Name: Phone No:
Location: Permit
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: Date: 7 — c2-1 - 6 ).-
Certification of receipt of materials covered by this manifest
COPY 1 - GENERATOR
NYC-WTC 000127314
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