Invoice for asbestos work, 57 Ann Street, November 2002

NYC 9/11 Public Portal Document

57 ANN 5T'gET -

ASBESTOS INSPECTION REPORT (continued) '~ 26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718) 522-2263 Disposal Site(s) BlueRIdge LartdM PO Box 399 Scottsdale, 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) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) © Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application r~ 30. LOCATIONS OF ABATEMENT r2c MA'i'EtZ-AAc. ' ~pjNC~"TE (T ~ ''~4) k .~ ~ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. en*e, east wing, roan #. (e.g. Pipe fagging. Cam. plenum SQt7ARE LINEAR PERFORMED boiler room, lobby, etc) (e.g. running cable, installing fire sprinklers, ducts tanks, etc.) FEET FEET removing and boilers etc.) ROOF Root= Sc~(zf a It225 PAI2 Pe=r L.3ALL5 (2.56 3csuc uEA.D moo Flue i eo es 500 PAQ.&PET Lbc 31A

31. 1 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.

of Air Print Na a of Print Name of Applicant (if other than Owner)

signature Signature Signature

I 6 03 o z- _~' Date Date Date 32. 1 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 a tos project. 1 hereby declare that I have authorized the filing of this notification for the work specified herein.

Print Name of Owner — signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. LA nv 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 ACPY 212001

NYC-WTC 000119711