WTC property inspection form, 67 Greenwich Street

NYC 9/11 Public Portal Document

NYbEC 1. -371 NYDCA 483056

Q beLo C an orLaLion o. Inc. P.O. BOX 1044 TOLL FREE PHONE 631-924-505Th--' HAMPTON BAYS, N.Y. 11946 1-800-755-OATC FAX 631-924-5085 "EMERGENCY NUMBER"

Waste Manifest # Job # Floor or Location Cust #

1. Work Site Name and Mailing Address Owner's Name, Address, Phone Number 3.E.P. O .T fix' , [ "; T. c i (' I i l \' i. L) . C NLW O K . O . V.

Contractor's Name, Address Waste Disposal Site .4 ADOUG L?. LAN -D TRI 20 1=')T'I .: T -':.E _ RT. _ . B X 6$ COLLEGE PC.' `:T Li B. DC7EPGg, 1' t:fi'.

Name and Address of Responsible NESHAPS Agency Other 0

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags - Cubic Yds. -

❑ RQ Waste Asbestos, Class 9, NA2212, PGIII ❑ Other Drums or Tons - OTHER - ❑ RQ Waste White Asbestos, Class 9, UN2590, PGIII Special Handling Instructions and Additional Information

OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled and are in all respects in proper condition for transport by highway according to applicable international government regulations.

Printed/Typed Name Title Signature Date (M D/YY) Transporter 1 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address Signature 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. P.O. BOX 1044 Printed Name: Date HAMPTON BAYS, NY 11946 Title: DRIVER Transporter 2 (Acknowledgement of Receipt of Materials) Telephone No. Company Name and Address 631-924-5050 ASBESTOS TRANSPORTATION CO., INC. Signature: P.O. BOX 1044 Printed Name: ( Date HAMPTON BAYS, NY 11946 ~i Title: DRIVER Discrepancy Indication Space:

Waste Dispos i Ow er a ator C cation (Receipt of Above Waste Accepted) Telephone No. L.::1 _ - -- Signature:

Printed Nam : Dat f I A i / Company Name and Address Title:

NYC-WTC 000128305