Invoice for facade cleanup services, 21 Ann Street, Jul 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT Jcontinued)

26. Asbestos Hauler I ES ( i Ny _ ________ NYS DEC Permit # NJ — 4 G ThI.# (718) 522-226.3

Disposal Site(s) PO BOX 39

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) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement t) ® Other (Describe) _c N —.. P ,_ --

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

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

•-rnur• nr ann Trnnr\IT Ares IA . flu's AA'LSAGt O A.. C - TA. 2

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 Tire sprinklers. (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum boiler room, lobby, etc) ducts, storage tanks, decking. etc.) FEET ' FEET removing and replacing boilers. etc.)

FACADE So t FAC.iO w 1230

F 2625 4

It Paeaf T LTvsE 330

PAgAPE7 wA,L 88~

It A/C O t TS _CJO

a Dot c.wc e,c 500

It E TEt.ID-cD WA,u_ 400

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.

~AQ~E 'P ,l ZBEWC;r ►1EEQS eE11_>A A t IA)R,2BAl 4 Set. C :R Print Name of Air Monitor Pn Name of Asbestos contractor Print Name of Applicant (it other than Owner) r 'L ignature Signature Signature

Date Date _ Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance air accordance with the Asbestos Control Program Rules. I have contracted the third party the asbestos abatement activities in 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. AYC PIKE o6 26 oZ _ _ Synatw Date Print Name of Owner

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

NYC-WTC 000116462