Invoice for roof cleanup, 125 Fulton Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECT TON REPORT (continued) - . -' , '.s,- ..-'.•,, NYS DEC Hermit•# 1 462 Tel.# u "f w 28. Asbestos hauler _1GSS, N'? yY

DisposalSites),5t.t}E 0CXaE LM, DffI(L PO BOX 390 'SC.oT5DAte 'PA

27. This asbestos abatement is part of a (Item a through a requires Sting of this form with NYC Department of Buildings) • 'a) ❑ Demolition b) 0 Boller Replacement c) ❑ Sprinkler Replacement • d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application 3n. LOCATIONS OF ABATEMENT io / 0 1 /' fl . DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION O WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing, room #, (e.g. Pipe lagging, celling, plenum SQl1ARE LINEAR (e.g. running cable, installing fire sprinklers, bolter room . etc) ducts. storage tanks, decking. etc FEET w FEET removing and replacing boUers, etc.)

Scx t ddDE sT') ti17a $owfl4 FAC.,rDE 1t „~Nr*s~s 672 ~ N u 13o. GPe ADE ) HT O 110 wnl Ps*c~►t

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.

F' HE`D c L-L'J e+t/D i j /t , fz 8GL/W$c Print Name of Air Monitor Print e of Asbestos tractor Print Name of Applicant (if other than Owner)

Signature Signature j Signature

Date Date

32. I understand that as the owner of a building where asbestos abatement activity occurs, lam 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. ii 66t141oZ Print Name of Owner signature Date

A 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 immediate!y in writing directly to the NYC DEP ACP.11 Asbestos or in y2Wt

NYC-WTC 000127882