Invoice for asbestos abatement work, Oct 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (cpntinuecd)

26. Asbestos Hauler tf=5l , Ny NYS DEC Permit #_i —462.. Tel.# C Z i 13) 522- 2263

Disposal Sites) 6WE ei D6t= LAUD Ft LL P0 BOX 3899 SC , TS DAt_E PA IT25.4

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) 0 Fireproofing Replacement 0 ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair LEI Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT ROOF MPrsrztAt : ltOOF M0TA CTAe DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room U. (e.g. Pipe lagging, ceiling, plenum SQUARE UNEAR (e.g. running cable, installing fire sprinklers. boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET FEET removing and replacing boilers, etc.)

ROOF ROOF Su A I38S1

II . Uu rt5 4 IATL 6000

N • u wnus 620 FACADE 4t Cc inr~~ c5 g j r it F Fet c ar sry 0

P it F ceea2 St c r 6 20

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.

U)4Ei RI AN ZarR— I$EE 3 A Pri Name of Air Mon P t a e of sbe t Contractor Print Name of Applicant (If other than Owner)

Si nature ignature Signature r /bI1lo2 to l t 102 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 authorized the filing of this notification for the work specified herein. , J41C DE? la IIi 0Y 02 Print Name of Owner ignature Date

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. ACPT 212001

NYC-WTC 000114263