Invoice from contractor to DEP for environmental services

NYC 9/11 Public Portal Document

~ t ASBESTOS INSPECTION REPORT (continuF ) 26. Asbestos Hauler I ESI, NYS DEC Permit # Nj'462 _ Tel.# (11E3) 522-2263

Disposal Site(s) LL D BOX 399 SC'OT5L>Ac.E PA 1-1254

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) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) ❑ C (Describe)

28. TYPE OF ABATEMENT (Check all approp~'iate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent 0 DEP Variance Application i• - CP tAt ' t7ff •J/ZG rt,t=ATkt7/5.13e. ',~ '~~! ov. iv...+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.)

RIoF c:YuNOER Sc:2FAC.E5 2600

FACAD T tae PW-ADE F 12 f< rcSCAFES 2 7'CO INCu1oe.3 µE STnt ¢ C°ASie

Ale- UwTs Ton c / i%A tZA Prc75 j 64.a>r`Iii /smex- veoNn I'2ob 2ooF £.coF Svrtcotc.t -s 43.42. r tco5 so(z4AC-S 1010 acic 3 t= rte a ti W At.. st:e < .mac i44

i of Ncezit FACAl>~ Sums 9285 n So .t FAc~.t 1115 u INTtdzeoe. IutEwce s /Tru'?st- 558

Federal, 31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with State and NYC laws and regulations applicable to asbestos related work.

i~)pp_P..EttJ 4 ?I Atjz fi4g E2S 13. Y-U2213At`1 q SON 0DWIZft t _ Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

rte ' Signature Signature Signature

Date Date Date

for the performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible contracted the third party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have have authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I filing of this notification for the work specified herein. /3yC DE-P C7t-08-02 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. II [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 ~1

NYC-WTC 000101852