Asbestos removal invoice, 29 Broadway, Aug 2002

NYC 9/11 Public Portal Document 4

ASBESTOS INSPECTION REPORT (continued) Asbestos 26. Asbestos Hauler Transportation CO NYS DEC Permit# 1 A-371 TEL.# 631-924-5050 DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies Valleyview Dr., PA 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) 0 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 0 Giovebag 0 Tent ❑ DEP Variance Application 30. LOCATIONS OF ABATEMENT hi (tor-41Jo110.. DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE PERFORMED LINEAR (e.g. running cable, Installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET • FEET removing and rep!acmg balers, etc. 30th tern No. 3 Setback Roof 2500 9th tern No. 3 Setback Roof 2000 6th tern No. 3 Setback Roof 2000 2nd tern No. 3 Setback Roof 2500 9th tern No. 3 Setback Roof 650 th tern No. 3 Roof/HVAC Equip. 7450 th Item No. 8 Facade/Walls 500 ourt- and Item No. 3 Roof 675 our - ard Item No. Facade 9450

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

Warren & Panzer Trio Asbestos Rvl.Crp. NYC P ' Name of Aa Monitor Rn Nan~,d Contractor Print Name of other than owner)

rgnalure Signature Signature

/ -17- 0,2 ' 7-17-02 16 2, Date to 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 Asbe s Contr Program Rules. I have monitor who is completely independent of all parties involved n th sb St s roject. I ereby declarecontracted the third party air that I havç auth rized the filing of this notification for the work specified herein. Trinity Morris Corp. c/o NYC Print Name of Owner Signature O e A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE W RK 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 ACP7 through the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000123543