Asbestos inspection report, 114-116 Fulton Street, June-July 2002

NYC 9/11 Public Portal Document

IESI NY COPORATION 110 5th .Street • Brooklyn, NY 11215 s h Phone: 718-522-2263 • Fax: 718-522-2697 MANIFEST

11239 DATE Z- 1. Job Site Address Owner's Oame Wait and Load 114-116 Fulton Sited Dept Of Eavlromenta1 Time In New York, N.Y. Prt>dectiOH Time Out

2. cvatractor~ ea = s_ _ & Drop Date

1248 Ralph Avenue Ni E Brooklyn, N'Y 11236 N E R 3. 1' tion WDS phone number

A P.O. Box 399 O Scot#and, Pa. 17254 html # 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 ofmaterials 6.VEH. LIC. # 7. TOTAL QUANTITY

(RQ) WASTE ASBESTOS 9, NA2212, III TYPE BAGS SIZE CUBICYARDS 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.

s Printed/Typed Name Tits( Signature Date '7/a' P 10. Transporter #1 (Acknowiedgetnent of receipt of materials) I DEC Permit No. O IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 11 15 JA-462 R ^~ E Pnn yped Name Title Si Date /D/Y R 11. Transporter *2 (Acknowledgement of receipt of materials) DEC PERMIT # w T Pti Name Title Si Data 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 012

Printed/fyped Name 4 k \tiJu ' Title ii4L,t& Signature g L __________ Date (M/D/Y) ¶ WHITE:LANDFILL • t3REEN:IESI • PINK:GENERATOR • YELLOW:CONTRACTOR • GOLD:JOB SITE

NYC-WTC 000128844