Invoice for roof remediation services, 111 Nassau Street, Jul 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ462 Tel.# (718) 522-2263 Disposal Sites) BiueRidge Landfill PO Box 399 Scotsdale, Pa 17254

27 This asbestos abatement Is part of a (Item a through e requires filing of UNs form with NYC Department of Buildings) a) ❑ Demolmon b) ❑ Boiler Replacement c) 0 Spnnkler Replacement d) ❑ Renovation/Afteration e) 0 Fireproofing Replacement f) El Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application + 7 "" ' ')`Q G 7 ~,/ `'~ ~ , ` V

30. LOCATIONS OF ABATEMENT fLOOFMATE21AL 1 (2)OF MEMBRANE CTAV-) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing, room a, (e.g. Pipe tagging. ceiling. plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET FEET removing and replacing eplaang boilers, etc.)

QoOF RooF SUQ-cAc.E 3842 it 4 tED6E' FAQAPET LoAt-L IT64 11 ABC VNIM 4 t4EThL 5 000 FACADE N At3 Sr. t &p€ ( T 2295 It' - WNIt3 GT2 it W IPDOL)S 6 12.

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.

Al2SLEM ` W KVRzg/W 4Sou Cc. ___-

Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (if other than Owner)

r _

Signal Signature Signature

S Date 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.

6'26 102 Print Name of Owner ture 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. ACP7 712001

NYC-WTC 000099067