Asbestos abatement invoice, 198 Broadway, Aug 2002

NYC 9/11 Public Portal Document

ASB S INSPECTION REPORT (continued)

26. Asbestos Hauler _I E-S I NYS DEC Permit # $J d - 46 2 Tel.# C, t B S22 226:3

Disposal Site(s) AWE P 060E L"D FIU. P O. BOK S99 SC.tsts o^om PA t Y 2 54

Department of Buildings) 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement f) 0 Other (Describe) _ ------------

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair 10 Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) _t ❑ Full Containment ❑ Giovebag ❑ Tent 0 DEP Variance Application .,.~f t' frf A.1 Q

R=F S004;4kCe= Poop MO'MBtZ 't' CTh ) ! - 30, LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED LINEAR SQUARE (e.g. running cable, installing are sprinklers, (e.g. entire, east wing. room #, (e.g. Pipe tagging. ceiling, plenum FEET boiler room, lobby, etc) ducts storage tanks, decking, etc.) FEET' ' removing and replacing boilers etc.)

looF PeQ rtn.i. SooF' ROOF 5uWACE 20s8 or RaF

Mt~T+ L 3lppaRiS 400

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

4U 1J i. PotwA Ivt3talia ate ' . f<o'rzPSAN S SON C, 2r.&. Print a of Air Monitor P t Name of Asbestos contractor Print Name of Applicant (if other than Owner)

Signature Signature Signature

O —t2 —OZ G'C~ t2—Q'Z Oats Date Data

performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air the asbestos project. I hereby declare that I have authorized the monitor who is completely Independent of all parties Involved in filing of this notification for the work specified herein. -oZ• Signature Date Print Name of Owner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE the NYC DEP ACP. rAny modification of Information provided on this form must be reported immediately in writing directly to requirements of the Asbestos Control Program Rules may not be lawfully avoided or ACPT

NYC-WTC 000123202