Fiber Control Inc Invoice for DEP Cleanup Services, Aug 2002

NYC 9/11 Public Portal Document S

ASBESTOS INSPE 26. Asbestos Haule Disposal Site(s)

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement - d) ❑ RenovationFAtteration 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) )T ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application 1 ?, /V V

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e-g. entire, east wing. room 1. (e.g. Pipe lagging. ceiling, plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers. baler room, lobby, etc) ducts, storage tanks. Oeddnq, etc.) FEET ' FEET removing and replacing boilers, etc

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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.

237 ( 7 Pnni N itor Pnn Name stos contractor Print Nam or App ant (H other than Owner)

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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 ling f this notification f r the work cified herein.

U Print Name or d dPner signature — Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. An modification of information rovided on this formmustbereportedimmediately Inwritingdirectly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throughtheperformanceof work In incremental or piecemealfashion. J ~1Dc1

NYC-WTC 000100144