Invoice from Fiber Control Inc for DEP, Sep 2002

NYC 9/11 Public Portal Document

7k' 7 Ijz ASBESTOS INSPECTION REPORT (continued) _

26. Asbestos Hauler ~O J0 NYS DEC Permit O Tel. ~ Cx 2.721 3a'o ? Disposal Site(s) O( e2 N t11i( 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) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement I) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑DEP Variance Application 3n I nrATlONC ne A A T &Irsr r DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g- entire, east wing. room i, SQUARE LINEAR PERFORMED (e.g. Pe lagging. ceding. plenurn (e.g. rvvtirtg cable. installing fire sp inklers. boiler room lobby. etc) .storsgetanks. eøing. etc. FEET ' FEET rsrnos.ing and replacing boilers. etc.

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I - ____________ ____ ____ _______________

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.

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Signature itor

€. _______ Name stns Conl,actor

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Date pate Date 32. ,1'!{ rstdr~dghat as the owner of a budding where asbestos abatement activity occurs, I am responsible for the performance of /.the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air /, y monitor wko is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the ti Qr~tffis twtifati` for the rk specified herein. J ti-~ si Cc a"Qef signature Date A 1hMPED CbPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Any fnbdificationof information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The ements of the Asbestos Control Program Rules may not be avoided or lessened through the performance of work in incremental or pieci Ncv7 taco+

NYC-WTC 000126238