Invoice for roof work, 29 Park Row, Nov 2002

NYC 9/11 Public Portal Document % —.

ASBESTOS INSPECTION REPORT (continued) - , Asbestos Hauler . IESI,NY NYS DEC Permit # NJ-462 Tel'# (718) 522-263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scottsdale, Pa 17254

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Akeration e) ❑ Fireproofing Replacement f) El Other (Describe)

28. TYPE OF ABATEMENT (Check aft appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair ® Cleanup

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

30. LOCATIONS OF ABATEMENT O i DESCRIBE SECTION AFFECTED SURFACES ! AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM 1 PERFORMED (e g entire, east wing, room #. (e g Pipe lagging, ceiling. plenum SQUARE LINEAR (e g running cable. installing fire spnnkiers. boiler room. lobby. etc) ducts, storage tanks. decking. etc.) ! FEET FEET removing and reptaang boilers. etc)

ROOF Roof Sc;RF,a►c►.E 3600 METAt.. Suir~ ge 500 It3CuTP S S UGUT i F CAttE ' WESI ..&cc >l ►.e oL Sc s►c 2CX'o

" FAc E ! ACAD Suu !2400 j

b ' i

f I

31. 1 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.

~tJAtbta 3 4 PAM ZWZ 636t 1t ERS B. ku¢ZaANA Sol Crr111I~A ~Ik. Pr,nt Name of AirMonitor --- Print Name Of AS Contractor Print Name of Applicant (H other than Owner)

Signature --- Signature Signature

11-15-02. 11-15-02.

32. 1 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 filing of this notification for the work specified herein. that I have authorized the

NrC1)EP 1i—is —o2. Pont Name of Owner — lure Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. [Anv modification of Information ptovided on this form must be reported Immediately in wrltlnq directly to the NYC DEP ACP. requirements Rules may not be lawfully avoided or lessened ACP7 212001

NYC-WTC 000115538