Asbestos abatement invoice, 196 Broadway, Aug 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (contir.'ued) ° . 26. Asbestos Hauler _. t E5(, NY NYS DEC Permit # Ns - 462. Tel.# t1ts) 522- 2263 Disposal Site(S) _OLVE MIOG E LRwD Flu. PO 80tc 399 SCotspA.t.E PA 112S4

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) 0 Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full containment 0 Giovebag ❑ Tent 0 DEP Variance Application ' 30. LOCATIONS OF ABATEMENT 40OF MAIUtAL.. % R.COF miemsp.&wra DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entre, east wing. room S, (e.g. Pipe tagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, FEET' FEET bolter roan, lobby, etc) ducts, storage tanks. deck , etc removing and replacing bolters etc

ROW Roof SUCLFAce 8360 4NCwDes i116u t,EDGE SET - t ctc RoaF 5ucz.F,s.C-a 1990 A/c uabTS, 'D CTS II MET ' . ACWS BSOO

PfAAt 't WAIA.S 500 FACADE WEST FAC.%'M Sttat=AcE 2650 U EAST pp.CAoE S'JZF1ikC.E. 2915 WAU. ADiA c V r0 WkAL S%JG`-PAGE'. 560 N s sc,A.vuEs WAIL 42.00 It FIRE Esca.arrs 2050 P. 31 t45 1050

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.

LoAeet $ PA$ZER. Ert41t ERs 'B. 2t3AM Sa C?C*3TCL hJC. Print Name of Air Monitor Prue ' me of Asbestos ' tractor Print Name of Appicant (If other than Owner)

Signature Signature Signature

-26--a2 oT- 2c —a2. OT 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.

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. Ar

NYC-WTC 000123147