Asbestos disposal documentation form, 2002

NYC 9/11 Public Portal Document

V CT, MA, RI, VT, NH, ME E.P.A. AGENCY NY GENERATORS #99 49007 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, Cr 06480 TELEPHONE (860) 342-0667 • Fax: (860) 342-4866 Boston, MA 02114-2023 (212) 264-6770 Out of State 1-800-272-3867 (617) 918-1111 #1-800-272-3867

FB# '4 n ASBESTOS DISPOSAL & DOCUMENTATION FORM Job Number .O. # GENERATORBUILDING OWNER Contractor FIBER CONTROL INC. 145 CHAMBERS STREET CORP Address ill NY 10007 . Address 3010 BURNS AVENUE City State Zip City WANTAGH State Zip 11?93 (51_781 Phone Number Telephone Number 07 GENERATING LOCATION Date Container Del. Date of Pickup Type of Container 100 YARD Address 145 CHAIVIBtRSSlI4ttI

VOLUME 114 CV Friable% Non-Friable ❑ City NEW , NY 101 Bag)< Drum ❑ Wrapped ❑ Other ❑ Phone Number INV * FlOSS 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: Address Telephone# Driver ration #. NY 1480138 AR Date: 07124A)2 Signature State / # Acknowledgement of receipt of materials.

Transporter 2: Waste na 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 ..mot • 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 / # A knowledgement of receipt of materials.

Landfill Name: Phone No: Location: Permit Approximate Volume of Asbestos Received: Discrepancy If Any: Received by: 4 Certification of receipt of materials covered by this manifest.

COPY 1- GENERATOR NYC-WTC 000127325