Invoice from Fiber Control Inc., 189 Broadway, Dec 2002

NYC 9/11 Public Portal Document

26. Asbestos Hauler • NYS DEC Permit # Tel.#

Disposal Site(s)

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 t) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ 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. entire, east wing. room #. (e.g. Pipe tagging, cuing. plenum SQUARE UN (e.g. running cable. installing fire sprinklers, boiler room. lobby. et ducts, storage tanks. decking, etc.) FEET ' FEET emoving and replacing boilers. etc.)

t~v C (for)

367 s7

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.

o h_ Y C~m- M7 y CcØ Print Name of rplicant (If other than Owner)

V ,7Pnnt,Name*&6f Air Monitor Print Nate of Asbestos Contractor

Signature Signature Signature

• ~ Date- .~ /(-_Z 2- Z- 1/ ____ Date Date

32. ! 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 !have autho ' ed the filing of this ngtificati for the work pecified herein. AP ~1SD Print Name ~ llh'J uz Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. writingdirectly to the NYC DEP ACP. I_Any modification of information rovided on this form must be reported immediately In writing

ACP7 2!100+

NYC-WTC 000123049