Invoice from Fiber Control Inc., 183 Broadway, Oct 2002

NYC 9/11 Public Portal Document

r Ot 7G ASBESTOS INSPECTION REPORT (continued) ,. 26. Asbestos Hauler ~O O NYS OEC O Tel. X72 3c 7

Disposal Sites) O! e2p IE li e 5Permul~ ( !"~ •/

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) ❑ Boller Replacement c) ❑ Sprinkler Replacement • d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation 0 Repair ❑ clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent 0 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. entire. east wing, morel. (e.g. Pipe egging. ceiling. plenum S0t1ARE Lvem (e.g. g Cable. installing fire s +ideas. boiler mom. . etc duds. tanks. . eta FEET FEET and mt,l5ctflg boilers. etc.)

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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.

P nt ll - ,vt mac( itor Name Contractor Print Na of App ant (H other than owner)

t`e Soature Signature

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 li of this notifcat' the specified herein. l Y~ i Print Name of signature Date 0 9)_ .. ' A'STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

L. Any modification of information provided on this form must be reported immediatelyin 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. r tm"I

NYC-WTC 000123001