Invoice for exterior cleanup services, Fiber Control Inc., Sept 2002

NYC 9/11 Public Portal Document t

ASBESTOS INSPECTION REPORT

26. Asbestos Hauler " Co NYS DEP .'."ermh 272 _ 7 Disposal Site(s)

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) ❑ Renovation/Afteration e) 0Fireproofing Replacement f) ❑ Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOD CONTAINING ACM PERFORMED (e.g entire, east wing. room N. (e.g. Pipe tagging. cuing. plenum SQUARE UNEAR (e.g nutnktg cable. instatling fire sprinklers. Doper mom. lobby. etc) ducts, storage tanks. dedting. etc.) FEET • FEET removing and replacing replactng 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 taws and regulations applicable to asbestos related work.

St1 Print N u _Fttit,4{tE itor . Name Contractor 23Th d G7 Print Na. of App ant (If other than Owner) , _ sgnature nature Sgnature

o C - o3 -- o; x _____

Date 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 notification for the work specified herein.

PruN )lame d Owner

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

oat J [_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 through the performance of work In incremental or piecemeal fashion. I pcPY t

NYC-WTC 000100476