Invoice from Fiber Control Inc., August 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler CO Q(j O NYS DEC Permit 0 5 Disposal Site(s) , 1t25. \/ f4 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/Afteration e) 0 Fireproofing Replacement I) 0 Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) Z ❑ FuII Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application /3 /J~

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room I, (e.g. Pipe lagging, ceiling, plenum SOUARE LINEAR (e.g. running cable, installing faro sprinklers. boiler room, lobby, etc) ducts. storage tanks, deding, etc.) FEET FEET removing and replacing boilers, etc

A3 tl r'1't--1 I. b

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.

C — __ Pant N itor Prin Name t star Contractor Print Nam of App at (If other than Owner)

C ~ . Signature nature v Signature

- o3-oa -3-02 Date Date Oate

32. I tinders,tand'that as the owner of a building where asbestos abatement activity occurs, lam 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 hits notification for e work ed herein

Print Name of owns Signature Date

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

L 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 piecemeal fashion. I ACP7 vrioot

NYC-WTC 000119792