Invoice for asbestos roof cleanup at 49 Nassau Street, July

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) }sbestos 26. Asbestos Hauler 'ransportation Co. NYSDECPermit# 1A-371 TEL.# 631-924-5050 oisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies/Rd 3 Valleyview Sr., PA 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) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovalion/Alleration e) ❑ Fireproofing Replacement Q ❑ 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 ❑ DEP Variance Application ~ )o 2

30. LOCATIONS OF ABATEMENT Y/n' J0 y ~/y

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM I DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room II, (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 boilers, etc.) Roof Item No. 1 Asphalt Roof 1875

acade Item No. 7 East Facade 1725

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.

Warren & Panzer Trio Asbestos Rvl.Cor NYC Print Name of 'r Monitor P' Na Contrador Print Name of Grant (H than Oer) Owner)

Signature Signature Signature

Date Date Dale me of As

32. I understand that as the owner of a building where asbestos abate t acti it ccurs, I am responsible for the performance of the asbestos abatement activities in accordance with the As stosMules. I have contracted the third party air monitor who is completely independent of all parties involy n e hereby declare that I have authorized the Cling of this notification for the work specified herein. d odLori Zee Corp, C/oPnNYC Print Name or 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 ACP7 through the performance of work in incremental or piecemeal fashion. 2/001

NYC-WTC 000099757