Invoice for roof removal, Fiber Control Inc., Feb 2003

NYC 9/11 Public Portal Document I

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler NYS DEC Permit —~ Tel. Disposal Site(s) cq l es , V*((W 4t I-,'l 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) 0 RenovatiordAtteration e) ❑ Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) El Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Application sn I ACdTin,.,C no ec ercue-►rr DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g entire. east wing, room it, SOUARE LINEAR PERFORMED (e.g. Ppe tagging, almg. plenum (e.g runngrç cable. installing (we sprinklers, booler room, Ioby, etc ducts, st aetanks. ded . etc.) FEET ' FEET removtnQ and re lad boilers. et ) F2ot j" BAc -ACA 11250

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.

/vl Cl~ ( Qul 2 ) Th d Pvu N ,tor Name CorWactnr Print Nazi of Appl nt (If other than Owner)

r Signature nature Signature

!late Dale Date 32. 1 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 performance of 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

P fCof this noti lion for the work ~specified~~herein.

Pratt of Stun Oats A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. EIArty modification of information provided on this form must be reported immediately in writing direct!y to the NYC DEP ACP. m e requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. A,ccr armor

NYC-WTC 000126161