Invoice from Fiber Control, Inc., July 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler Co c3 MA) 0 NYS DEC Permit Oi Tel. Disposal Site(s)

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) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Cleanup 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑Tent ❑ DEP Variance Application /~ 30. LOCATIONS OF ABATEMENT ~fi ®~ o DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing. room #. (e.g. Pipe tagging. ceiling. plenum SQUARE UNEAR (e.g. running cable. installing fire sprinklers. baler room. lob , etc ducts. store a tanks. decki , eta FEET FEET removIng and replacing boilers. eta

31. I 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.

Sc~~ c#Fttits~t Pnnt N r itof LAA — vmCc2 Prin Name/f e L[1— stos Contractor x)ihôAl Print Nam of App cant (if other than Owner)

S!9nature nature Signature

--3 _02. Date Date Date

32. I understand that as the owner of a building wh re asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordanc with the Asbestos Control Program Rules. I have contracted the third party air monitor who is cpmpletely independent of all rties involved in the asbestos project. I hereby declare that I have authorized the filing of this n ificatio or the work specified erein. D/ Print Marne of owner Signature Date

, &,STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK 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 through the performance of work In Incremental or piecemeal fashion. Acrr 2a001

NYC-WTC 000127343