Asbestos abatement invoice, 83 Maiden Lane roof project, July 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler I ES , M 1~ NYS DEC Permit #_I'.1- A 62 Tel.# ( (18) 52.2-22.63

DisposalSite(s) SWEP_A0rmE LAaDFILL PO BO$ 399 ScOTSDALR PA IT254

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) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application /~ /, 3o LOCATIONS OF ABATEMENT RAOF M&-cEtz+Ai.. t e 3BRER "/ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. Pipe tagging, Wiring, pienum SQUARE UNEAR (e.g. running cable, Installing fire sprinklers, (e.g entire, east wing, room #. boiler room. lobby, etc) ducts tanks, decking, etc FEET ' FEET removing and repladng boilers, etc.)

ROOF Rooc Sun.FA 2A96 M IOOI.E goOF Sc,' 804 4AA1N ¢oo>r PooF' S3 Y694

it iii FL s cat RcoF S0 ACE 169 h u MEr~• .. Succ.,E SO SAN Fr. (3 nnS 4 LeD&ES __ 2 wluflows

31. 1 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.

upaaa 4 PR.tzER. Es . rateFZs B. %u ALJ 4 Co► to oi_ Print Name of It Name of tos Con or Print Name of Applicant (N other than Owner)

ignature Sig e Signature

O '- IS - 02. o8-is-a2, 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 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 thisnotification for the work specified herein. MYC'DEP a8 -15-O2. Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. the NYC DEP ACP. Any modification of information provided on this form must be reported immediately in wilting directly to the Asbestos Control Program Rules may not be lawfully avoided or lessened h the performance of work in incremental or piecemeal fashion. 2/2001

NYC-WTC 000102400