Invoice for work at 122 Nassau Street, Oct 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 6. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718) 522-2263

Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buitduigs) / a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 RenovaboMAlteratso

e) 0 Fireproofing Replacement I) El Other (Describe)

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

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

30 LOCATIONS OF ABATEMENT 2c01= µATTc'1 I /rct t 1')OOF M4 J BR.s J CT ) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM I PERFORMED SQUARE LINEAR tog running cabte. .nstau.ng fire spnnkterS, tog entire east wing room n i to g Pipe tagging. ceding, plenum FEET FEET removing and replaorig bodefs etc • coder room, lobby etc) ducts. Storage tanks decks . etc }IElp.t2 ROOF ReoF eFAC[ ( ar) 25 s '< a«+ ei F 5uI aE Um a 25

C

31. 1 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.

Print Name of Air Monitor I /P rint Name t Ashes S Contractor Print Name of Appi~cant of other than Owner)

Signature S. attire I Signature

- -- - Date - -_-_--~ _ Dat -- ------------_----- j Date

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.

Print Name of Owner Signature 113,02 Date

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

I Anymodification of information rovided on this form mustbereportedimmediatelyinwritingdirectly 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. ACe? 21200+

NYC-WTC 000098703