Invoice from Fiber Control Inc., 22 Barclay Street, Aug 2002

NYC 9/11 Public Portal Document r

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler NYS DEC Permit if CTO1 Tel. -a7 .3& Disposal Site(s) _%ot I1ekP l JeS \ 1*(('( F '(

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) ❑ 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 ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application ~ ) / ~,j' +'~ a fl LOCATIONS OF ORATRIUt=tiT If ' 1 / f / / A_#i t DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF VORI< BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing. room #. (e.g. Pipe lagging, ceiling. Plenum SQUARE LINEAR (e.g. running cable. Installing fire sprinklers. boiler room lobby. etc) ducts, tanks. . etc.) • FEET removing and replacing bailers, etc FEET' ( l of i I

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.

Pint N itor Prin Name os Contractor Print Nam of App ant (If other than Owner)

Signature nature Signature

Co 03 0~ • (o ___ Date 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 ~J~his tifi ti for the work specified herein.

Print Name Owner Signature Dee

40 TAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

s.~ 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. +r 212001

NYC-WTC 000119844