Asbestos remediation invoice, 47 Ann Street, July 2002

NYC 9/11 Public Portal Document y r ANN 5TIZ.rCET ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel!# (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254 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) 0 Sprinkler Replacement d) 0 Renovation/Aferation e) ❑ Fireproofing Replacement t) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation 0 Repair t9 Clean up

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

zn IA[_ATIfFCr ARATFUGWT 2C MA` TLt .Tr3 JLAC=mCaa-Ai3r= DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running able, installing fire sprinklers, boiler room, lobby. etc) ducts. storage tanks, dedring, etc.) FEET FEET removing and replactng boilers. etc.)

ROOF r~coc sc:l2Fsi.cE 3625 It Atz-Ac 't tEr .E. 340 it A ae P E T (,,t)A U.

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.

Print me of Air for PnnI N e of As tos Contractor Print Name of Applicant (If other than Owner) 1

ignature Sig azure Signature

Date Da Date

32. I 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 filing of this notification for the work specified herein. OC (oA Print Name of Owner Signature Date

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

Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP.

The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or p.ecerneal fashion. ACP? a2o0t

NYC-WTC 000119461