License agreement for exterior clean-up, 2002

NYC 9/11 Public Portal Document

S& NASSAU S*Te -r ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI.NY NYS'DEC Permit # NJ-462 tet.# (718) 522-263

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 Buildings) a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) 0 Renovation/Atteration e) ❑ Fireproofing Replacement f) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal ❑ Enclosure ❑ Encapsulation 0 Repair 4 Cleanup 29. ABATEMENT PROCEDURE (Check all appropriate boxes) /t„ ~/~ ~?/ 0 Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Application / 4° l

30. LOCATIONS OF ABATEMENT ROOF ►Aa-rS-, , L RooF MEl-1BPAtltr CTA(Z) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e g. entire, east wing, room It, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts. storage tanks, decking. eta) FEET FEET removing and replaang boilers, etc.)

RooF Poor- St.st2F —. i9

F t OE T FACADE __ B'JLK UEkt,s 2CC srr A , RccF FACADE S n 2.340 FACADE EA$c ROAD i

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.

('~'~ 5 I R N ~L IIJ ice% QZSAN_ C.0 iJ i'TZ...L ---- ------ ----------- ---- --- ---------------- ----- Print Name of Air Monitor ` Print ame of Asbestos actor Print Name of Applicant (if other than Owner)

Signature Signature Signature

C:T (e1 (oz —eTct — — 'e2— — Date Date 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 a estos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. i j _ _ 1laYCRAP cyl t t I OZ Print Name of Owner Signature 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 212001

NYC-WTC 000099256