Invoice for roof cleaning, 92 Warren Street, Aug 2002

NYC 9/11 Public Portal Document r

ASBESTOS INSPECTION . REPORT (continued) 1 26. Asbestos Hauler_ CD Qi /f W 0 NYS DG -C Permit ! ~ Disposal Site(s)

27. This asbestos abatement is part of a (Item a through e requires filing r'a+9 of this form with NYC Department of Buildings) ~ `~ ~' '• _ a) ❑ Demolition b) ❑ 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 . ❑ 'Glovebag ❑ Tent ❑ DEP Variance Application 30. LOCATIONS OF ARATFMr=uT DESCRIBE SECTION I AFFECTED SURFACES I AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED (e.g. entire. east wing, room #, (e.g. Pipe tagging, ceiling. plenum SOUME LINEAR r r • ARE (e.g. running cable, installing fire sprinklers, boiler room, lobby, dc ducts, storage tanks, dedci ,etc. 'FEET• ' FEET ' femovlpg and.replaong boilers, etc. R4'rD $ ffi 4— . ' o0

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.

Pant N it cc~tr4Mtc itot Prin Name f As l stos Contractor ,4,cJ1 l ( S(fr Print Nam of App nt (If other than Owner)

Signature gnature 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 filin of,hi otification' for asbestos project. I hereby declare that I have authorized the work s ecified herein. - _,,.

nt Name of Owner . .r A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE - Signature J j Oat

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. ie Asbestos Control Program Rules may not be lawfully avoided or lessened the performance of work in incremental or oiecemeal fashion. Acar 2 oo1

NYC-WTC 000112927