Invoice for facade and roof cleaning, 120 Liberty Street, Jan

NYC 9/11 Public Portal Document

(continued) ASBESTOS INSPECTION REPORT NYS DEC Permit#_CT-098 Tel.# 130-272-3867 osHauler Logano 2 Southern Alleghenies Valley Landfill Disposal Sites) this form with NYC Department of Buildings) a (Item a through e requires filing of 27. This asbestos abatement is part of d) 0 Renovation/Alteration b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement a) 0 Demolition Q Other (Describe) e) 0 Fireproofing Replacement f) appropriate boxes) 28. TYPE OF ABATEMENT (Check all ❑Repair ❑Clean up 0 Enclosure 0 Encapsulation ❑ Removal appropriate boxes) 29. ABATEMENT PROCEDURE (Check all ❑ Giovebag ❑ Tent 0 DEP Variance Application ❑ Full Containment I ete+ATrnuS OF ABATEMENT DESCRIPTION OF WORK BEING AFFECTED S1 AMOUNT OF ACM DESCRIBE SECTION PERFORMED OF FLOOR CONTAINIrIG ACM I SQUARE LINEAR (e.g. running cable, installing fire sprinklers. Floor(s) (e.g.Pipe agging. ailing. plenum FEET (e.g. enure, east wing, room #. FEET boiler room, lobo etc ducts, lge ks

DEP .$ ENT RE BUILDING AS PER

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

Fiber Control, Inc. Fiber Control, Inc. A.T.C. Associates Applicant (If Debar than of Air Monitor 'lPflnt Name of Asbestos Contractor Pri

Signa~ nature

responsible for the performance of where asbestos abatement activity occurs, I am 32. I understand that as the owner of a building contracted the third party air accordance with the Asbestos Control Program Rules. I have the asbestos abatement activities in parties involved in the asbestos project. I hereby declare that I have authorized the monitor who is completely independent of all herein. filing of this notification for the work specified form As per cleaning request Date Print Name of Owner Signature AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING DEP ACP. this form must be reported immediately in writing directly to the NYC [ Anv modification of information provided on Rules may not be lawfully avoided or The requirements of the ACP7 22001

NYC-WTC 000108263