Invoice for exterior cleanup work, 86 1/2 [name], 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler i E5i N --- -_ NYS DEC Permit # N.!-Q62--- Tel.# _(-ct&L522-226

Disposal Site(s) tktE w D6E LAIJDFtt~ PO BOX- 3 g9 SC Ts_vgc.E— PA _IT2 S4

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) 0 Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ 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 0 Glovebag ❑ Tent ❑ DEP Variance Application l~yf~~ ~ ~L '2n 1 fl1 ATIr NS OF ABATEMENT BATEMET . 4 ut ~" //f1 I ( ô Y DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUAIIE LINEAR (e.g. running cable, installing fire sprinklers, (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum FEET FEET removing and replacing boilers, etc. boiler room, lobby, etc) ducts, storage tanks, decking, etc.)

ROOF P-ooF 5QR-FAC`k 119G

FACADE t__ FA E 805 II AWNi 1JGt5 600

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.

U f7.(2.E'N S P Z- ENE, HJ DS B. IQ Q2(3AN 4 SGi~ CO tRcL Name of Air M nitor Print Name of sbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

__ 01102 (OZ Date Date Date -

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party 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. e`zzc 5 N7L-Ot'T' o? 0 07 — Signature Date Print Name of Owner SITE. - ' A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK DEP ACP. Any modification of information provided on this form must be reported immediately in writing directly to the NYC 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. ACP7 Zoot

NYC-WTC 000098964