Pest control invoice, Benjamin & Son Control, Nov 2002

NYC 9/11 Public Portal Document

310 Jouti ST ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler IESI,NY NYS DEC Per it # NJ-462 - Tel.# }(718) 522-2263 Disposal Sites) BlueRidge Landfill P0 Box 399 Scotsdale, Pa 17254 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair ® Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent 0 DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DES ~1,UL►79NJ2 IPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing, room a, (e g. Pipe lagging, ceilin9• plenum SQUARE LINEAR (e g running Able, installing fire sprinklers, boiler room, lobby, etc) ducts. storage tanks. decking, etc.) FEET FEET removing and replacing boilers. etc

FAc _ WEST FAcacc. S:Se c c 5200 " S__ tl a II 000 It AWN INCAS /5i L B

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31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work.

1'4ARel _A _ANz- - 2 Cftf; ' wacpS 2i3A14 F SCI,, l2bli-rIX- L. Pnnt Name of Air Monitor rin ame of best Contractor Print Name of Applicant (It other than Owner)

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32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. ,~. _ 1.30 102. Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP.

The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000092821