Invoice for fiber control services, 43 Park Place, Oct 2002

NYC 9/11 Public Portal Document - ) -

ASBESTOS INSPECTION REPORT (continued) 28. Asbestos iiauier i-.O 3~'s~7 Disposai Site(s) U e2 i/ NYS DEC Permit e 5 1*([( Tel. /~' !^ I ~ 2 ?.Z ^

27. This asbestos abatement is part of a (item a through a requires citing of this form with NYC Department of Buildings} . :j a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinider Replacement • d) ❑ Renovation/Alteratlon e) ❑ F reproofng Replacement 1) ❑ Other (Describe) 28. TYPE OF ABATEMENT (Check all appropriate boxes) 4 ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check ail appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent 0 DEP Variance Application 30. LOCATIONS OF ABATEMENT - DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM ft DESCRIPTION OF WORK BEING Floor(s) I OF FLOOR CONTAINING ACM PERFORMED (e.p enUve. eau 9, morn S. (e.g. Pipe 1699in9. ce 4. P SQUARE 11EAR (e.g. muting cable. kstalling fre sprinklers, bailer 'corn. ete ducts. storage Lanka, etc. FEET • FEET remote and re boilers. etc

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.

Prnrtt crMri~ftt: itor il iUly ~xJ Name CorvraClor Print Nan of App nt (tf other than Owner)

Sgnatwe nature Sgnatwe

Date Date Date

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 that I have authorized the ii of this notifi n for the rk specified herein. ~.-- Pant Owner Signsturo Gate

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

[IAny modification of information provided on this form must be reported immediately In wtitinp directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throuqh the performance of work In Incremental or piecemeal fashion. I X" e of

NYC-WTC 000115897