Asbestos abatement invoice, Corona site, June 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler IESl,NY NYS DEC Permit # NJ-462 TeL# (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdaie, Pa 17254 27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) 0 Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT (cooF M oT T2i /k L. ; QoQF U t_1V I3tzsA. - 4 1"Weeww oue 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 t.NJEAR (e.g. running cable, installing tire sprinklers. boiler room. lobby, et ducts. s< tanks, decks etc.) FE removing and repladng boilers eta

t_c ' (2 oP ' AC 3000 GUL..OE-AC$S 800 PAP-P' r L45%e 2 pp,R-s.p e-r- "-AU_ 2.40

31. t 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.

e2J 13 /t"A- 16&. ' Print of Air or nt Name bestos Yactor Print Name of Applicant (it other than Owner)

t•GL~(.L L~ ~ Signature Sig re r Signature

____________

Date (/o3J6 0 -

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 involy a a stos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. ..• i Print Name of Owner _ signature Date

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

modification of information provided on this form must be reportedImmediately 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. ACP1 212001

NYC-WTC 000119634