Invoice for roof remediation work, 123 Fulton Street, Jul 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION IjEPORT-(continued) 4 f ~

28. Asbestos Hauler _ii5i , N9 NYS DEC Permit if 9:.462- •* Tel.# C--cts5 s22— 226 3 Disposal Site(s) - BUE V-4M _ UU+ol=t u. PO Box S cSDA 'C~'00'. t72S4

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) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement t) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation 0 Repair JK Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent 0 DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room re. (e g. Pipe legging, ceiling, pie urn SQUARE (e.g. running cable, Installing fire sprinklers, boiler roan. lobby, etc) ducts, storage tanks. decking, eta) FED PEST removing and replacing boilers, etc.)

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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.

t,3A PAMC e. E .tt as Jae IL k -'r. d/l//S . P me of Air Monitor Pr nt ame of Asbestos or Print Name of Applicant (If other than Owner)

Signature Signature Signature

i6 6//qo_ ___________ Date Date Date

32. I 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 Asbestos Control Program Rules. I have contracted 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 filing of this notification for the work specified herein. r ~szP ®6 9102 owe it Print Name of Owner Signature

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

EAny 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 riot be lawfully avoided or lessened through the performance of work In incremental or piecemeal fashion. Acts 212001 .

NYC-WTC 000127829