Invoice from Benjamin Kurzban & Son Control Inc., 111 Fulton

NYC 9/11 Public Portal Document

I

a IESI NY CORPORAON 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

1114 990 DATE_ e- z/0i1 1. Job Site Address Owner's name Wait and Load

111 Fulton Street Dept Of Em-11.10 Pt edit'111 Time In New Yotk, . V. Time Out

2. C tat Drop Date gticlg T ai5~ 4Y& Son 1148 Ralph Avelltaw t rooktyn; NY 113Ô Ip E N E R 3. p s t~ttiE;tl'natlit~ a d~yR ?lltdtdl"~tion WDS phone number A P.O. Box J99 T O Scotland. Pa. 172'4 !~yeS in 1t f' 100934 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 CUBIC YARDS 8. Generator Certification

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. ;

Printed/Typed Name Title- Signature Date (M !y P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O R IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 1x215 JA-462

T 1 ! `'/ -DRIVER .r ~, /~c►, . E Printed/fyped Name Title Signature j 1 Date (M/D/Y) '1 R II. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A T Printed/Typed Name Title Signature Date M/D/Y E 12. Discrepancy indication space

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

Printed/ryped Name } Title Signature Date (M/D ) // WHITE:LANDFILL • GREEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000128727