Invoice for roof cleanup work, 34 Park Row, Oct 2002

NYC 9/11 Public Portal Document

--® ASBESTOS INSPECTION REPORT (continued) " .te a.._

26. Asbestos Hauler t F S1, N1-? NYS DEC Permit # Nd - 4G_2. Tel.# (1t2+) 522- 2263 •

DisposalSite(s) Blue t.40GE t.AmD i-L _PO 60X 399 SC o-csDA1.E. PA (T2S4

27. This asbestos abatement is part of a (item a through a 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) ❑ 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 0 Glovebag ❑ Tent 0 DEP Variance Application 3n LOCATIONS OF ABATEMENT Iaf MA.TEW.4At. t Qoo F' MEM62-[VJt. DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, Installing fire sprinklers, (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum FEET boiler room, lob , etc) ducts, storage tanks, decking, etc.) FEET ' removing andreplacing boilers.etc)

00f QOOF S 0P- 30007

FACAOE izr i<ACADE Sum "S 1500 it is FiILE ESCAPtE-S IS _

FACAoe. 1.)oR, t 4 * S 2000

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.

wow" ?s z.eaa€$Gi E5 3. iEu ArN A CgsNT Contractor L _ Print Name of Applicant (If other than Owner) Print Name of Air Monitor P t N me of A8

Signature Sign a Signature

09 (23102. ___

Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performanceparty air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third monitor who is completely independent of all parties involved in the a bestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein.

Signature Date Print Name of Owner

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. writingdirectly to the NYC DEP ACP. Any modification of information provided on this form must bereported immediately in writing

ACP1 as o1

NYC-WTC 000115399