Invoice for facade cleanup services, 30 West Broadway, Sep 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION (continued) ' REPO,, TR,,, 26. Asbestos Hauler _ Co 4 /f ' 0 NYS DEC Permit —O Tel Disposal Site(s)

27 This asbestos abatement is part of a (Item a through e requires d Wit • filing of this form with NYC Department of Buildings) a) 0Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration' ` e) ❑ Fireproofing Replacement f) ❑ 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 0 Glovebag ❑ Tent ❑ DEP Variance Application 30. LOCATIONS of eaeTr-UCKrr DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED (e.g. entire, east wing. room #, (e.g. Pipe logging, ceiling. plenum SQUARE batter room, lobby, etc) UNEAR (e.g. running cable, installing fire ducts, storage tanks, decd . eta) FEET ' FEET sprinklers. removing and replacing balers, etc.) bD . 3? 3~ il, 1 F1 3E[ }G t S'i S tCL ,-t• c c a, o c~ S qC rte) 01 ~ l

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31. I 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.

+ 5~~ tFFtar f 7dv ` Prnt N ita Prin Name rAsbpstos Contractor Print Nam of App cant (if other than Owner)

Signature nature Signature oC- o3--oa G-3 -c __ 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 -'i7ioriitoG who is!completely independent of all parties involved in.the asbestos project. I hereby declare that I have authorized the filing of•this notification for the work specified herei

•• ~.. Pent game of r Signature Date MPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. on this form must in writing directly to the of the Control ram tcutes may not be lawfully avoided or in incremental rw niar.maal fa¢hinn ACP7 212001

NYC-WTC 000109771