Invoice for cleanup services, 101 Maiden Lane, 2002

NYC 9/11 Public Portal Document

AS Q$ INSPECTION REPORT (continued)

26. Asbestos Hauler ___I Esl2_ wy _ NYS DEC Permit #, .4&.__ Tel.# Cl t2) 522-2263

Disposal Site(s) a+~E wvGE t 3DFtL~ P.0 IBM 399 50-orSDAt.e 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/Alteration e) 0 Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation 0 Repair ® Clean up

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

,in I CATION OF ABATEMENT Q op MAr A-~ : R.00c WM13%ze.Ne CT ) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.9• entire, east win9• room N. (e.g. Pipe 99 n9• plenum n9• ceiling, lagging, SQUARE LINEAR (e.9 running cable, installing fire P sprinklers, boiler room• lobby, etc ducts. storage tanks. decki . etc.) FEET ' FEET removing and replacing boilers, etc.)

RpoF t3,)uc 14 D5 QDCF 4 WAu. SueFAceS 1367 tt Pi*APCr U. Au. WAu- SvecAct- 5 IoIG

It 2ocrr S:xR. ACE 3636

if )4Th 5u2P a c, S 300

214D FL Seer BAC.v- eoc SU¢.F•,~c.E 300 CAD 1.Iceri1 FAeAOC SJa.FAc,Es 2100

tt EAs+ (PEAt2L Si) WlsDouw tL1EOG>r$ 21$b t1 FACADE S'UeP e,C S 2625 I W EST

Ii (Ni_WOR FACADE S¢FACES 215 a Sot rttil (M to L e) FACAm SUR. c s IIT I S INCW DES AwwllaGs 4 S DtE iic. s

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.

ul`At<R t POW-44 R G96L1 EEQ•5 8. ku ,t 4 S `O viz . I NC _ Pri ame of Air for rint ame of As stns C rector Print Name of Applicant pt other than Owner)

Signature Signature Signature

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 asbestos project. I hereby declare that I have authorized the filing ofthi§ notification for the work specified herein. I,IyC DEP 013—ts-02 _ Print Name of Owner Signature Date —~ye , )II41AMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

\ti,'• , ny 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 000099968