Invoice for environmental services, Nov 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) • 26. Asbestos Hauler I ESI NY NYS DEC Permit # 13.1-462 Tel.# C't I BJ _ 22.Z 3 ~.

Disposal Site(s) gwE DrawE LstaD clot-- Po Box 399 ScOTSDA-t 1'A Yt254 •

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) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement f) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application —mov, / 2i 9' (i- t]?''

4n I r ATIr kIC nt: Ai2ATGMGNT S.,.,G• ►A67 iAL : t=se.At1EL q •'Tfr"ta Pikpe-x 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 #, boiler room. lobo . etc) ducts, storage tanks, d etc.) FEET FEET removing and replacing boilers, etc.) OPPct' /B.ACV- ftac F Tom. £P duTi l m.s R~~ca~ surrz, 420 13&UPes 6:xtc. titAD tZocc e li 7G uNirs id tAWrP4. Soo MAIN ___ 20©i- Sot 884T set t_ S QZ*rAcC 1000 2ND Ft., CcOF Sutziesf a 1 WA SSA( MAIDEM LSE S tDC u¢ rae,c+r Ad 2424 s t#.r s•.a~ /aa.e ataes ►t C►ct.*_ Starxr StbE wac+~ 1 i69A

FACA'vt_ ttstt Otz 4840 11 tDrc4 iatsE Sir taa(J

6T I G G~ca s-= .S~zl- ,t fAeaDtb S - IIZ E 4240 mot Sl2 ' it ,,,e.oc S,¢, a ce 12200 Iu1A.t~aE1.1 L e,,ai2

31. f 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.

e 4 PAI41Z Z EaGta B. iug.zi_ 4 St u G iu'ec Print Name of Air Monitor Prin ame of Asbestos for Print Name of Applicant (If other than Owner)

Signature Signature Signature

tt v~st(Zia2 D 112162 Date 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 authorized third party air monitor who is completely independent of all parties involve the asbestos project. I hereby declare that I have the filing of this notification for the work specified herein. ,.... ,r~rrcv os li2 ltn. Signature Date Print Name of Owner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE InwritingdIrectly to the NYC DEP ACP. • [Any modification of information provided on this formmustbereportedimmediately

AM 212001

NYC-WTC 000102268