Invoice for work at 118 Nassau Street, July 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

A6. Asbestos Hauler IESI,NY NYSE DEC Permit # NJ-462 _ Tel.# (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale. Pa 17254 r ,

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 RenovationiAfteration ,< e) 0 Fireproofing Replacement f) El Other (Describe)

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

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

eCU F M A'TElZt At_.: P-Ctpl EM B R.A CTs& 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM ( PERFORMED SQUARE LINEAR (e g running cable, installing fire spnnklers. (e 9 enore, east wing,room a le 9 P~a Ilagging ceiling.plenum P I FEET FEET removing and replacing boilers. etc Doter room, lobby etc) ducts, storage tanks decking etc 1

(ZOO •1 Rocs~ets io5 t' I fAZl+.t~Et WAu. ! 4 07 I sr BAci~ sew Room RooF sywc/tC.E (Nc )i 5GO

FACh0E `WEST rM4LDE (wSS/wsr) f I25 1

C. 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.

Pint Na e of Air Monitor ! Print Na of As stos Contractor Print Name of Applicant (If other than Owner)

nature" .gn ere I S gnature

pz Date ------,~- ~3------- az ---------------- Date Date

32. 1 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. ` — 77EP — o (1',3102 Pnnt Name of Owner Signature Data

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 L through the performance of work in incremental or piecemeal fashion. ACP1 2/2001(

NYC-WTC 000098780