Invoice for remediation work, 141 Fulton Street, Oct 2002

NYC 9/11 Public Portal Document

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ASBESTOS INSPECTION REPORT (continued) _® 26. Asbestos Hauler _1E51 N NYS DEC Permit # NS- 462 Tel.# (Yt8) 522- 2263

Disposal Site(s) 'E a.ti a LA ND Fcu. PO Box 3~9 Seo*SDALrc PA 1"1254

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

2$. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair ® Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

3A_ LOCATIONS OF ABATFMFNT t'dr('c is w rGa Ai : i2cor Irf I L'.At1. 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 lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable. Installing fire sprinklers, boiler rocm, •ob , etc) ducts, storage tanks, decking, etc.) FEET ' FEET removing and replacing toilers, etc.)

Rcct= Icot= 5t."P.FJAC~ 21 ti AIG'. ' w t-s 4 METAIL ' 3000

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Pacace Sc-14 CAve I cAD'rrr Spa •C + 910 it Ns .n( A.^—Ao FACADE S.: -4 re

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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.)ilt N k i3A+ZC'R EI loeeeS p, f Ccur2s,c. Print Name Of Applicant (If other than Owner) Print Name of Air Monitor Print N e of Asbestos C tractor

Signature Signature Signature

c1-26 --r:s _— Date Date Date

32. ( 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. ' a ____________

Print Name of Owner Siignature 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 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. ACP7

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NYC-WTC 000127997