Invoice for Asbestos Abatement Services, Jan 2003

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler Logano Trucking NYS DEC Permit # CT-098 TEL.# (800) 272-3867

Disposal Site(s)Southem Alleghenies / Valley Landfill

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

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging. ceiling, Plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room etc) ducts, storage tanks decking, etc FEET FEET emovag and replacing boilers, etc facade 1,850 roof isphalt 496

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.

A.T.C. Associates Fiber Control Inc. Fiber Control Inc. Print Name of Monitor Pri t Name of Asb ,sloe Contracl r Print Nam of Applicant (It r than Owner)

Signature gnature re

Oale Data Date

32. I understand t as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of "bespbest b t e activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air etely i dependent of all parties involved in the asbestos project. I hereby declare that I have authorized the l n for work specified herei . ~ l k..I Ct c - ~'i vL. I Prim Name downer Signature

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 through the performance of work in incremental or piecemeal fashion. 2/2001

NYC-WTC 000108301