Invoice, Benjamin Kurzban & Son, Sep 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) _• • 26. Asbestos Hauler I4ESI . NY NYS DEC Permit # U3- 462 Tel.# C•t(8) 522-22 3

Disposal Site(s) _BuIE ¢+ D6 E LM > D Ftw P0 BOX 399 SCo•t'S'D (~ E PA I T 2 54 ' •

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) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

'An t M ATIANC nF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room >l. (e.g. Pipe lagging. csTing. plenum SQUARE LINEAR (e.g. running cable. Installing fire sprinklers. boiler room. lobby, etc) ducts, storage tanks. decking. eta) FEET ' FEET removing and replacing balers. etc.

ROOF QaoF SQZFACG 2522

S_ACAe- PxOF S 4FAc G '72 8 it 4rc 4 #A rte' 1000 FACo tie ED'S; f?+c FACAOE S s9_FAC.c`. 2C BO tt We Sr F7v-,^Ve 4e Sic.rr~e-c 234i(3 Ft Pic TCSCAPrc"`.. 2-100

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.

(Daaa 4 PR13%aa ctt ai s 'B. e : .t 4 Sow &►sftel- Print Name of Air Monitor P ' t ame of nos Contractor Print Name of Applicant (If other than Owner)

fl9'- Signature ___________

Signa ure _________

Signature

C'9- C c2. 09-GS-c2 Date Date Date

for the performance of 32. 1 understand that as the owner of a building where asbestos abatement activity occurs, I am responsible contracted the third party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. ( S~_ ~NyCl~ZrP E7cJ l OSlt:2 Signature Date Print Name of Owner SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK DEP ACP.iIIJ Any modification of information provided on this form must be reported immediately in writing directly to the NYC Rules may not be lawfully avoiaea or ACP7 W2oot

NYC-WTC 000115230