Invoice from Fiber Control Inc., 128 Chambers Street, Sep 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTIQN REPORT 26. Asbestos Hauler _) g ' NYS DEC Permit Disposal Sites) O l Y CK N (rC Vl C.1.7 V I& t' r t

27. This asbestos abatement Is part of a (item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement • d) El Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

3n. LOCATIONS OF ARATFMFPT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room 0. (e.g. Pipe tagging. Wi g. pIemm SQUARE LINEAR (aa g cam. stafltng fire ms s, holey room, lobby. etc) ducts. storeCe tangs. denting. etc SET • T removing and replackie boilers, etc.) A-s P c 90 5~1

•1 ______ __ __ _______ 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.

VTb Pnm ( sctM4Mtc itor 25f Name lvxi Contractor 1,)Tha Print Na or A{4f (17,i m (if other than Owner)

Signature Sigtretture

Date We Date

32... turidesstand that as the owner of a building where asbestos abatement activity occurs. I am responsible for the performance of ilk asbestos at3at intent activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air morn or veto is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the i this for the work specified herein.

-Print Name 0( ^they signature Omi

~.'A5'P,ICMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

the Asbestos Control Program Rules may not be lawfully avoided or lessened

NYC-WTC 000127432