Invoice for roof and facade cleanup, Fiber Control Inc., Oct

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 0 - 1 A

26. Asbestos Hauler - Co NYS DEC "ermit Disposal Site(s) .eN;e5 r \Ii4- 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement • d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement q 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 Floors) OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing. room 0. (e.g. pipe tagging, cefnD. pbnum SQUARE M EN (e.g. sunning cable, ttstaning fro apmklem. boder room. lobby, etc) ducts, tanks. dedtinq. etc.) ET • FEET ' and boilers. et

Qtj I_(iprLk)

1 I 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.

c E a Pnftt itor Name Canbactor Print Na . d App M (N other than Owner)

t Sgnature naturo SiDnatur'e

Date -3-c 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 pf this notification for the work specified herein.

fR`Prdt Named owner _______________ Signature I Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

An modification of information provided on this formmustbereportedimmediately In writing writingdirectly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throuqhtheperformanceof work in incremental or piecemealfashion. through J Ate srmot

NYC-WTC 000100468