Asbestos abatement invoice, 176 Broadway, Aug 2002

NYC 9/11 Public Portal Document

'ASBESTOS INSPECTION REPORT (continued) `. , 26. Asbestos Hauler tE51, NY NYS DEC Permit # WS-462. Tell.# CTl8)'5Q2.2263 Disposal Site(s) Bt1JE 24 otaE1ADFtU.. P0 BOY, 399 Sco-rs Ate PA 27. This asbestos abatement is part of a (Item a through e 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 ROOF SU2t=ACt : ROOF 1MElu6 RANE C TAR) 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 tagging. ceiling. plenum SQUARE t.tNEAR (e.g. running cable. installing fire sprinklers. boiler room, lobby. etc) ducts. storage tanks, deckingeta) T FEET removing and replacing boilers. etc.) ROOF PJX F Sotat✓AES (Au) 90t3Z '" Deets 4 d/c uauS (ML' 23000 N Ew c. WoR.tc k FNG $JCa 3000 13ut4igE7OS C AU1 4300 ser eAc&' ftCOF f2ooF SuizFad 2809 Pano A uwoo Fas* cit 6, 2500 so~rnt focAve (l{(AIDEN LAME) FACADE SuacE 4 py, It x 3 .5 5210 No"A BADE (3ottnt S•rtesr) FACADE StsnzFAC 122SO VA9R' FACADE REAR OF B ..DG tx1rNDOLa'a @ t.EDEQES 10395 (trE~f FACAm (BeoAou;AV) FACADE $ 4535

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.

WgltR.GO 4_PAtAZ4M e"10Et=lZS Print Name of Air Monitor S. KuRZBA13 4 Sos Coinyot. JW_ ` Prin Name of Asbest s ontrac~r ^-._.. Print Name of Applicant (if other than Owner)

Signature Signature Signature

OT- 03 —62 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'this notification for the work specified herein. MYC. t OT. 03 — o2. Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Any modification of information provided on this form must be reported immediate!y in writ!ng 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. AM 212001

NYC-WTC 000122662