Invoice for Benjamin Kurzban & Son, 78 Dutch Street, 2002

NYC 9/11 Public Portal Document -? 7+~. s aur~; • ~•t s ~„-, rua-~r ,~x; sr~~; x,. ;m v- :w~ v -sue tw p L, ti ,:.~- .F..

IESI NY COI ,g;TION 110 5th Street •Brooklyn, NY 11215 Phone: 718-522-2263 • Fax: 718-522-2697 ----T MANIFEST / /.S

1 1112 DATE 1 1. Job Site Address Owner's name Wait and Load 7 loch S1reStreet Dept of Environmeotal Time In N YNeWYe1t,N.Y. Proted14l1 Time Out

2. Cr rg grs naar~+e akW s & Drop Date

124k Ralph Avenue G E Prooklya,NY 11236 N E R 3_ ~~tion WDS phone number A P.O_ Sox 399 o SScotland, Pa 17254 Peel # 10b934 R

4. Name and address responsible agency (Local, District or EPA Office where notification was sent)

US EPA 290 Broadway, New York 10007

5. Descriptionofmaterials 6.VEH. LIC. # 7. TOTAL QUANTITY (RQ) WASTE ASBESTOS 9, NA2212, III TYPE ' BAGS SIZE Z. 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 y propershi ing name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by A highw ac26rn applicable international government regulations. N S Printed/Typed Name Title Signature Date (M/D r P 10. Transporter #1 (Aelmowledg•ment of remipt of materials) O DEC Petmit No. R IESI NY CORPORATION • 110 5th Street, Brooklyn, NY 1215 JA-462

E Printed/rypedName Title Signature Date MID R 11. Transporter #2 (Acknowledgement of receipt of materials) DEC PERMIT # W A ^+1 IS Printedlr erne Title Si ture Date )/ •

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 E

Printed/Typed Name litIe ignature Date ( .1

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

NYC-WTC 000130761