Asbestos abatement invoice, 180 Broadway, Aug 2002

NYC 9/11 Public Portal Document G,.' 1E.>W I L...• ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY t NYS'DEC Permit # NJ-462 Tel.# (718) 522-2263

Disposal Site(s) BlueRidge Landfill PO Box 399 Scatsdale, Pa 17254

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/Aiteration e) ❑ Fireproofing Replacement f) El 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

30. LOCATIONS OF ABATEMENT /O +t 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 lagging, ceiling. plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts. storage tanks. dediing. etc.) FEET FEET removing and replaang boilers, etc.)

ROOF ROOF suarl%CES I$G6 q PA¢.AP~a*rs T02 R Boo Y 1414 a WA-i. 1O S..crc F SvtLFAC H6 i it MC UM1i DUCTS 5000 Vt 5 KAeso6 FACADE Sa3tZ:FAC.E I'ZW 31L0 It.. %.,vE' te.a►st' FACADE f'ACADe Stzz.^Ce 60013

FACADE AG&OE 5u $A -e 1800

- 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.

WARREW4 `i~A13ZC4t tWEB ZUIL-CO ►M 4 SON C 3IW0L __ Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature ___phSignature -- Signature

oY-o9-02 rrt-09--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 this notification for the work specified herein. / ~~C%~ix /WC DEP 07-09-0 2 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 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. ACP7 2!2001

NYC-WTC 000122825