Invoice for roof and facade cleaning, Dec 2002

NYC 9/11 Public Portal Document

' t 7 -eGt /9/7/-fAJO z_ ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler_ L~ NYS DEC Permi Tel. 8'~

Disposal Site(s) c) e2P //E ~-eN je S "Jr-((e(Li' 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) 0 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 ARATFMFNT 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, lobby. etc) ducts, storage tanks, decking. etc.) FEET FEET removing and replacing boilers, etc.) o

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.

__ r-r ct ~t tit ref / C7J )l .i l Prnt N ~r itor Prin Name f Asb stns Contractor Print Nam of App nt (If other than Owner)

r Signature gnature Signature

e 0_ _ _ 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 cootracted the third party air monitor who is completely independent of all parties involved in the asbestos project. I hereby declarethat I have authorized the in f this nottficati r the wor s ecified herein.

Print Name of net Signature Date

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

LIIAy 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. ACP7 srzoo1

NYC-WTC 000113126