Invoice for facade cleanup, multiple Broadway locations, September 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) • 26. Asbestos Hauler C & NYS DEC Permit -0~ Tel ~~~ '3a'v 1 Disposal Site(s) _QU I 1'7€kP ff"f1E? Je S /_\J L f"t /( 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 ❑ Encapsulation ❑ Repair ❑ Cleanup 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application ./' / 30. LOCATIONS OF ABATEMENT LA /) (9L? Ht. D 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 laggiing, ceiling. plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers, boiler oom lobby. etc ducts. storee tanks, decking, eta) FEET ' FEET removing and replacing boilers, etc.) rr yt " dc: ________

7~J G1 ~v+1 ••~ _________ ___ ___ ____________

&ACC

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.

Sc-t rt c4 ntht+ktY lvt U7J _ AZ __________________

Pant ftor Prin Name f As stns Contractor Print Nam of App ant (If other than Owner)

k< >4 Signature ` . a

nature g Signature

Date 0,9 a --3 --OZ 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 i Phis notificati for the work specified herein.

Print Name of tT Signature Date

. .ii~m ATAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

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 ACPr ao1

NYC-WTC 000119815