Asbestos abatement invoice, 196 Broadway, Aug 2002

NYC 9/11 Public Portal Document

ASBESTOSNNSPECTION REPORT (continued) 26. Asbestos Hauler _% - F5I , NY NYS DEC Permit # NJ - 46 2 Tel,# L1t8) 522- 2263

Disposal Site(s) tL$E iClOGE L O Flu. PO BOX 399 ScerSpA%E PA (1254

27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 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 0 Enclosure ❑ Encapsulation ❑ Repair ® Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full containment ❑ Glovebag 0 Tent 0 DEP Variance Application 4n 1 APATIANS OF ABATEMENT QGOF M&?•CeE1ALS .COF 41XIARMAME DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE UNEAR (e.g running cable, installing fire sprinklers. (e.g. entire, east wing, room #, (e.g. Pipe lagging. ceiling. plenum FEET ' FEET removing and replacing boilers. etc. boiler room, lobby. etc) ducts. storaq tanks. dedirng. etc.>

ROOF ROOF Sc;CFa c 8360 INCu;flcs t.1+6t't l EPEE SET - gooF S c e.0 1990 A/C ua(TS, 'DvCiS 4 8500 it Marst. S AC-

a PARAPET WAU.S 500

FACADE WEST Faca.o SucxFA a 2650

tl 01ST FACADE Sua.p, c 29 1. WALL ADAAe t)r r0 II A CAD Q W *t.L S ZACE. 5603

11 t"a`i' a<sa Es c `aE UM4. S.>ttuco.,cE 4200 U FtEE ESc av S 2.050 N Aw••1r MCltS 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.

(R:AeCEN 4 PAAZ &4 1 042E96 3. 2a M Sty Cr g=&- Na I Print Name of AirMMonitor Print dme of Asbestos ntractor Print Name of Applicant (If other than Owner)

v Sgnature Signature Signature

O_ T-2G—o2 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 air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party 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. ~ __ NYcta~ 0-26-0 2 ` Signature Date Pent Name of Owner

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 direct!y to the NYC DEP ACP. I The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP1 211001

NYC-WTC 000123133