License agreement for facade cleanup, 111 Fulton Street, July 2002

NYC 9/11 Public Portal Document

a ~ - WI NY CORPORATION 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

111490 DATE ___ Owner's name Wait and Load 1. Jcb Site Address 111 Fulton Street Dept CT aNiro h -e4'ectt< t Time In Y o, NV NeW Time Out

Drop Date 2. a J & S"111 I24 'Ralph Avenue Brooklyn, NY l 4436 a - E N E R 3, 4ltatlii k1Ja14$jl (8r ition WDS phone number

A P.O. Box 199 T O Scotland, Pa. 1U54 Pelrstil 0 101:1934 -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 CUBICYARDS 8. Generator Certification

_______________ _______________ 4 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 /2Q c. . S Printed/Typed Name Title Signature Date a NE P 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 1 j 215 JA-462 _ E Pnn ypedName Title Si tuts T T Date 'IV R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A S Signature Date(M/D/Y) Printed/Typed Name Title T 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

i l

.' r Date (M/ Printed/Typed Name Title Signature

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

NYC-WTC 000128758