Asbestos abatement invoice, 198 Broadway, Aug 2002

NYC 9/11 Public Portal Document

2tfit. Mb. s Hauler Sti 4k NYS

Disposal Sites lAfIDFILt PO BOIL ___99 n 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 ti) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) r~, 0 Removal ❑ Enclosure ❑ Encapsulation ❑ -:;~ air ~ i ' r an up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT Ill SJ2cACE: ROOF MEM8R~.1JE e DESCRIBE SECTION AFFECTED SURFACES r AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) j OF FLOOR CONTAINING ACM PERFORMED I (e g entire, east wing, room # (e g Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobb , etc ducts, storage tanks, decking, etc FEET FEET removing and replacing boilers, etc,)

QvCF (Ptti t coF' of Spec C E 10 8 of eooF ! Meru ~ : ~PPcRrS 400

4Ii________ ___ ___ * L - _ __--___

31. t hereby declare that the information provided herein is true and comp ete to the best of my knowledge. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos relates) work.

i t)gvg eN PO t'1- E WC, t a+ C le-•, _ E3Ar, it Sc ry G> ti eau. Pant eat Air Monitor Pnrt Narne of Asbestos Contractor Print Narne of Applicant (II other than Owner)

Signature S g lit uin S,gnature

c`(-12-0 2 Date Date Date

3!. 1 understand that as the owner of a bu King where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance w th 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 f have authorized the filing of this notification for the work specified herein.

Pnnt Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

An 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 y _ through the performance of work in incrernental al fashion.

NYC-WTC 000123196