Asbestos fiber analysis report, ATC Associates, July 2002

NYC 9/11 Public Portal Document Aug 02 02 12:46p ACTION/FIBER S167613065 p.1

I K CITY

Notification of Staging And Outrigger Beam Use By Special Riggers Please file 2 copies 'or Cranes and T ENT oc Derricks. pus copies for your own .ise RIIILIIINGS Anniiearicr. Must Ba Ilveewritten 1. Location of Job Borough: Manhattan House No(s).: 30 Street Na is: West Broadw&y Special Place Name: No. of S:Dries:

NOTE: The following items are to be submitted with this application. 1. Site plan / too' plan showing: protection; anc the entrances and driveways to the building A) Building outline; setbac<S; building heights: adjacent builoings; s:cewalk bridge/other :) Location o trio equipment. D) Tie-bacKs, safely tines and how they are secured 8) Label the streets and traffic direction. 2. Side view and front view of equipment showing• A) Max toad picked. staying, oferhang, etc. B) Material, size and dimension of the equipment, ;r:_iuding :he outrigge• beam, the C) Size and details on all rigging hardware and connections (i.e. tie-downs, blocks. sracxias, hooks, cramps, bolts and oulteys. etc.) D) The make-up and weight of the counterweight E) Planking / support order legs. F) If wheels or toilers are used, show blocking to prevent lateral movement. G) All relevant nfornation and rotes.

2. ,Job information Job Description Descr:ce & Sketch E;uement Stich As Pipe Staging and Dutriggers Beams ro Be Used t4sacn Skein Tc This Form)

Expected Start Date: Approximate Duration of Jot):

3. Spedal RI er Information First Name. ML: Last Name: F.BW rd Lioense No.: 5549 Business Name: Fiber Control, Inc.. Address: 42-14 sty Long Sale: ZIP: 11101 Phone: Fax: ~+

4. Owner or Managing Agent Information First Name: M I.: Lent Name: Business Name: orpugh o Manhattan Community College Addree 30 West Broadway city New York state: NY zip: 1 0007- 1 92 Phone: Fax:

• I certify that the subject work and setup of equipment will be done under ray supervision or under the supervision of (Supervisor. Foreman or Specie Rigger) The work wit, be done -n a safe and workman like manner punishable by a line or imprisonment, or both. • Falsifloabon of any statement is a misdemeanor under Section 26-124 of the Administrative Code and is accept. any benefit, monetary or otherwise, either as a gratuity for propedy performing the • It is unlawful fb give to a city employee, or for a City employee to Job or In exchange for special consideration. Violation is punishable by imprisonment or fine or both. Stgneture of Licensed Rigger Oats

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