Invoice from Kurzban & Son Control, Inc., 122 Fulton Street,

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IESI N~ UuKjfV ATION 110 5th Street • Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 —"7 MANIFEST f

11109 DATE ~ /z y/cd L.

1. Job Site Address Owner's name Wait and Load 122 Fulton Street - - Dept of Fn 'aot rental Time in N Y New York, N.Y. Protection Time Out

2. C Drop Date & SOA Y~l~ffit 12.48 Ralph Avenue G Brooklyn, NY 11236 E N E R 3. s i WDS phone number A P.O. Box 399 T 0 "Pa 17254 Perm $ # 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 Z CUBICYARDS 8. Generator Certification

T 9. CONTRACTOR CERTIFICATION: I hereby declare that the contents of this consignment are fully and accutately described R abcie by roper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A highw co g to applicable international government regulations. N S Printed/Typed Name Title Signature Date M/D P O 10. Transporter #1 (Acknowledgement of receipt of materials) DEC Permit No. R IESI NY CORPORATION • 110 5th Street, Brooklyn, NY i)15 I JA-462

R Printed/Typed Name Title S azure Date M/D/Y R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W

T E Printed/f 12. Name Discrepancy indication space Title Si urc De/L7/Y)

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

Ir 'lA- 1 Printed/Typed Name Title Signature Date (M/ )

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

NYC-WTC 000128979