Invoice for Environmental Services, 83 Nassau Street, 2002

NYC 9/11 Public Portal Document

83 t AsAiJ Si -

ASBESTOS INSPECTION REPORT (continued)

6. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718) 522-2263

2 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) El Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment 0 Glovebag 0 Tent ❑ DEP Variance Application 1 ys ~ 2. 'an I CX ATIfNS OF ARATFNIFNT I OOF : OunF MFM 132Al. L4kr .eJAt_ w/ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e g entire, east wing, room b SQUARE LINEAR leg running cable, installing fire sprinklers. (e g Pipe lagging, ceiling, plenum boiler room. lobby. etc) ducts, storage tanks, deGun . etc FEET FEET removing and replaong boilers. etc

QOOF R.coF Sut2~c2 2816

M I 113W" 7sos 4 A ~C V u 1 r5 1000 SET eko,ct - tzoCt- RooF 5~2~►c~ 432. FACADE j WTcsT .VE Suo .e VT-5S

F 1200 I I

_ _____ H- __ ______ _______ I__ i __ j _________

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.

WAe z s 4 PANEZ 6Jr.i 3 S Print Name of Applicant (If other than Owner) Print Name 01 Air Monitor~ Print Name sttosGontractor

Signature Signature Signature

t,11~z10-Z 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 of this notification for the work specified herein. — ~\ , NYCDFp 1t. 'ITto2- Print Name of Owner Signature Date

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

An modification of information rovided on this formmustbereportedimmediatelyinwiltingdirectly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through theperformanceof work in incremental or piecemealfashion. ACP7 moot

NYC-WTC 000100643