Invoice for work at 120 Nassau Street, July 2002

NYC 9/11 Public Portal Document I -L .d ..d % W-T-- L

ASBESTOS INSPECTION REPORT (continued) NYS DEC Permit # NJ-462 x._ Tel.# (718) 522-2263 6. Asbestos Hauler IESI,NY ' Pa 17254 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, of 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 RenovationlAfteration

e) ❑ Fireproofing Replacement f) 0 Other (Describe)

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

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

an I rI ATIAt•.IC AC ARATFL1 JT b,-.-c DOOF tAe'MBP..sai,. a CT re-) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR (e g entire, east wing. room a I ! CONTAINING ACM LINEAR (e g Pope lagging, ceding, plenum PERFORMED SQUARE (e g running cable, installing fire spnnklers, FEET FEET removing and replaCing toilers. eC) boiler room. lobby etcl duds. Storage tanks den . dcl

SU2FACE tt PA"MT W 443 It Mtn wOtztc 30 l4 5r T/' Z&DE µA5SA~1 j ' 425 i a Fuze ^PEE 2 C?0

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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.

Print Name of Air Monitor ! tint N me of $tns Print Name of Applicant (If other than Owner)

Signay gna e Signature

9 -- — 1r D ate -- T U Date

32. t 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. DEP _ cc. Ii'3 IOZ Print 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 through the performance of work in incremental or piecemeal fashion. I ACP7 V200t `t::ii

NYC-WTC 000098787