Invoice for asbestos abatement, 49 Ann Street, September 2002

NYC 9/11 Public Portal Document --t r'rvN J I Kit= r

'ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718) 522-2263 Disposal Site(s) BlueRidga 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) 0 Sprinkler Replacement d) 0 Renovation/AlteratIon ) a) 0 Fireproofing Replacement f) 0 Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT QcooF MAT _ P7rir,c Mt<MGSID~&1 DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing, room M. (e.g. Pipe tagging, ceiling. plenum SQUARE LINEAR (e.g. wnrting aadle, installing b tine etc.) sprinklers, boiler room, lobby, etc ducts, st tanks, decking,etc.) FEET FEET removing and boilers, etc,

ROOF PcOF• SURFACE 30(X) -T RAPI U.~ALL 240

PA tz+'PeT LED6E 24 0 ~.;4Ut IDs '752 Sc BACK 4TO A/C UIJi'iS 4 CX)Cr7NG 2800

5'e r VAcs. PAfz p-~j 532

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 e of Air ' itor J('/L. 2,C3_ /►/ Print me sbasics '^i ntractor Print Name of Applicant (It other than Owner) —

I _ - — — — — --- --- -- — — ---------------- —_ — ignatur Signature Signature —~-

~ Oat Date 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.

Ir 4 02 Print Name of Owner Signature Date

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

L Anv 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 piecemeal fashion. I AC,, moo'

NYC-WTC 000119541