WTC waste manifest and labeling guidance, Feb 2002

NYC 9/11 Public Portal Document — MJhb4ihTIe NY DEC # NYDCA#

Transporter Name, Address: Emergency Telephone: Telephone Fax: Number:

Waste Manifest #

1. Work Site Name

WTC INDOOR DUST CLEANING PROGRAM

Contractor's Name, Address Waste Disposal Site

Name and Address of Responsible NESHAPS Agency Other

U.S. EPA REGION II, 290 BROADWAY, NEW YORK, NY 10007 Description of Materials Bags: Cubic Yds

RQ Asbestos, Class 9, NA2212, PGIII Drums or Tons OTHER

Special Handling Instructions and Additional Information:

OPERATOR'S CERTIFICATION: "I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded and are in all respects in proper condition for transport according to applicable international and national governmental regulations

Printed/Typed Name Title Signature Date (m/dd/yy)

Transporter I (Acknowledgement of Receipt of Materials) Company Name and Address: Telephone Number Signature: Printed Name: Date Title: Driver Transporter 2 (Acknowledgement of Receipt of Materials) Company Name and Address: Telephone Number Signature: Printed Name: Date Title: Driver Discrepancy Indication Space:

Company Name and Address: Waste Disposal Site Owner or Operator's Certification (Receipt of Above Waste Acceptance) Telephone Number Signature: Printed Name: Date Title:

R*a. w~Gttir t

NYC-WTC 000130611