Invoice from Fiber Control Inc., August 2002

NYC 9/11 Public Portal Document

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ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler -.d NYS DEC Permit Tel. Z723 c ? Disposal Site(s) UI e21v l rt e s L 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 ❑ Clean up

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

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entiire, east wing. roan #. (e.g. Pipe tagging, fi g. p1e SQUARE LINEAR (e.g. running cable. Installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks . etc • FE removing and replacing bolters, etc.) FETE?

e4 MPbfM-c boo __________________ [ _______________________________________________ _____________________________________________________ _________________ ________________ __________________________________________________________________

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______ ________________ __________________ ______ ______I _______________________

31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. I amJamiliar with Federal, State and NYC laws and regulations applicable to asbestos related work.

S t~ t~ tL Jc- t4 at a t,M Y g, 3 ? y C1S74 N / _ t -s•-' f Print N !tor Prin Name Asbpstos Contractor Print Nam of App ant (If other than Owner)

Signature nature q Signature

L)C9- 03 oC --~ --02 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 asbestos project. I hereby declare that I have authorized the filing of thnotificati or the work specified herein. ~.. Print Name of Owner s"ttxe Date

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

1_Any modification of information provided on this form must bereported immediate!y in writingdirectly 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 piecemealfashion. ACPr v2001

NYC-WTC 000122625