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← Document results/DEP Box 52/102-104 FULTON STREET 1001196, 78/21
Document / 7 pages

Invoice for environmental services, 102-104 Fulton Street

Machine-extracted title · confidence 95%

Invoice from Benjamin Kurzban & Son Control Inc. dated August 1, 2002, for work at 102-104 Fulton Street.

NYC-WTC_000128658–000128664

Folder label: “102-104 FULTON STREET 1001196, 78/21

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Scanned page image, NYC-WTC_000128664
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OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

MANIFEST

11777 1. i >- Fii'V 'o '(* Wait and Load ,• •r Time In *~"~• Time Out

2. Cc D d We Drop Date BrocklyI,1VY 11231 G E E 1W BlUe Ridge L,1 hl Ceiporat1o!! R 3. st ts S) name, mailing address and physical site location WDS phone number A Scot1i4Ps. 17254 Peimd # 100934 O R

4. Name and address responsible agency (Local, District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

5. Description of materials 6,VEH LIC. # 7.' TOTAL QUANTITY

(RQ) WASTE ASBESTOS 9, NA2212, III TYPE ' BAGS SIZE 4 CUBICYARDS 8. Ge rator Certification

ci

T 9. CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A highway according to applicable international government regulations. N S 2 Printed/Typed Name -Title Signature Date(M/D/Y) P 10. Transporter # l (Acknowledgement of receipt of materials) DEC Permit No. O I Y CORPOR TION • 110 5th Street, Brooklyn, NY 11 5 , P JA-462 R T DRIVER h-46 E t me Title tore Date (M/DIY) R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A I Prin ypedName Title St acute SCVDIY) E 12. Discrepancyindication space

S

T 13. Waste disposal site owner or operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item #12 E

1 Y (tit ~.t, aa t _ •- ~1 - Printed/Typed Name Title Signature Date (M/D/Y)

WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000128664

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NYC-WTC_000128664Source: NYC Law Department, mirrored locally

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