Invoice for asbestos abatement, 119 Fulton Street, July 2002

NYC 9/11 Public Portal Document .. __. ..., r . . .—• IKB

~r *SBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler IESI.NY NYSOEC Permit fe NJ-462 1'eL# (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 e requires filing of ttrie form with NYC DeOranent of Buildings) a) ❑ Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replsoement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application 0 'v 30. LOCATIONS OF ABATEMENT RQric M. rtcv i s t , Q,-c F AAt-1R RAwt r- (T7 1 DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room 9. (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR PERFORMED boiler room, lobby, etc) (e.g. running cable, installing fire sprinklers. ducts, storage tanks, decking, etc.) FEET FEET removing and replaang bolters, etc.) ACAOE So0iU TACAOE 2250 NOR11( FACADE 2250 Wt T fCAD e 2500 . AWN1uG 2.00 PAe-,nom evoc ISOO 1f PARAPET ()Au. 8eLi a ► (500

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.

i )4 /4z 4 i/ oL t/ Print Name of Air Monitor Print me of As os actor Print Name of Applicant (if other than Owner)

Signature — ---

/J2?) -- --- Sgnatu~r~ p̀/ ~--,F—r 2 le 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.

- PEP o6't2 I o2 Print Name of Owner natrxe 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 OEP 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. ACP7 2noot

NYC-WTC 000119590