Invoice for asphalt cleaning, Nov 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler (0 0 NYS DEC Permit CTO Tel. Disposal Sites) DU 22 l~ ie s \1*(L'7 - ?(Vi( 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) r' a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Atteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal 0 Enclosure 0 Encapsulation 0 Repair 0 Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application, ij_, 3n LOCATIONS rlr APA'r uu cr //// DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire. east wing, room a, SOUARE LINEAR PERFORMED (e.g. Pe tagging, ceang. pieun (e.g. tunnmg cable. i stalling fee winkbrs, baler mom,lobby, etc) d,Cts. stoage tanks. . etc.) FEET FEET ismovin and replacing bolters, etc.

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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.

St1rs CLJ~~oLstat#tL M CTld 142iThìd

1(c tto Name Contractor *FriniNalmn App ant (If other than Owner)

Signature + . _______

gnatura _______

Signature

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 Ii •of tl d notification r the wo specified herein. authorized the

Print kame of r sgn.l,re Date

r ` 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 through the performance of work in incremental or piecemeal fashion. I Acai ta=1

NYC-WTC 000112875