Invoice for facade cleanup services, Fiber Control Inc., Oct 2002

NYC 9/11 Public Portal Document S

ASBESTOS INSPECTION REPORT

26. Asbestos Hauler NYS DEC Permit CJOt I C Tel. 8 ' ^X7 3 <% 7 . Disposal Sites) O l it CK N t9'n' C J IL i c { ' ( 'L 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) 0 RenovationlAiteration e) ❑ Fireproofing Replacement fj 0 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 ❑ Tent 0 DEP Variance Application

30. LOCATIONS OF ABATEMENT. DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) I OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing. room d. (e.g. Pipe lagging. pd^g. pknum SQUARE LINEAR (e.g. naming cable. instaihng Ire sp inkbrs,. boiler mom bby, etc) duets. stoiagetanks. d.dt g. etc.) SET • FEET vefnowing an rept.cing boilers. etc.)

~~ ro nn

__ .1 ______ _______ __ __ ________

31. '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.

— 27sa t" tl at at l4R iv ~~~.yt/t Plus itor Name convector a App m (tt other than Owner) Prau Na .

signature nsa~s signas<e O 03-O 2 --02 ` ___ Gate 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 Wifuation for the work specified herein.

Pnnt Name of Owner Signehne J,..,_ 9/_ A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

[Ipiny modification of information provided on this form must bereportedimmediately In writing writinpdirectly 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. saoo+

NYC-WTC 000100462