Invoice from contractor to DEP for environmental services

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continuf )

26. Asbestos Hauler I £5I. N`r NYS DEC Permit # 131- 462 _ Tel.# (I ( t3) 522—'223

D BOX 399 SCaTSDAtt ?p 1T 254 Disposal Site(s)

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

e) 0 Fireproofing Replacement f) ❑ C (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application '~CC•~'r n.,..i.r' LA ..rG1>t F i~ti<TA;kQJSd31=. ',~ ov. t tv~DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers, (e.g. entire, east wing, room #, FEET ' FEET boiler room, lobby. etc) ducts, storage tanks, decking, etc.) removing and replacing boilers, etc.)

aDp¢ (:YhNDER Sc:2FAc.E5 2600

FACADE -_tote FACADE F 12 E ESCAPES 2 7C0 INCWD€ µE STAIR C°ASt=

A% uuirs Tod F C'r` / PAVAPES/ Aw,tctaG.S /si > is (?06 P-00 P...c0F Sv2co c ES 4342

~act~ 3~U Fc _ sug4k^ S 1O1O u tt uJAu.. i484 DoE Ncezlt ~Aes.v~S s 9285 it P -mss 11115 u INr a4oZ Iut +ce S , s/T1zeST1E5S58

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.

t~:ARP..E"N 4 71 t2Ee ENUrNE'Ee5 uJQ26At.1 q SON CCMrQ I - Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

rte ' Signature Signature Signature

C7- pg —O'L v C-08 —02. — Date Date Date

performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for thethe third party air contracted the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I i:ave authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. auYC DEP C7C-o8—U2 Signature Date Print Name of Owner AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE directly to the NYC DEP ACP.III [Any modification of Information provided on this form must be reported immediately in writing avoided or lessened The requirements of the Asbestos Control Program Rules may not be lawfully fashion. through the performance of work in incremental or piecemeal t

NYC-WTC 000101852