Invoice for asbestos abatement at 44 Gold Street, Oct 2002

NYC 9/11 Public Portal Document

3ESTOS INSPECTION REPORT (continued) Asbestos Hauler IESi, NY NYS DEC Peumit# ut '`t G. Tel.# ( 1 tS' 52? -2263

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

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

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

I of ATIAINC AF A ATRMFNT RAbF Skit=AP.E I Q.c0t< ME l?At. a (TAON DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING loor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE UNEAR (e.g. running cable, installing fire sprinklers, boiler roan, lobby, etc) ducts, stotege tanks, decking. etc.) FEET ' FEET removing and replacing boilers. etc.)

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i 3 . 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.

W.4e ew 4'lam-tt C-nt6ttse6`¢s !3. K••Zat3AN Sc=; C.ct~rgct.. Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

_______________________ Signature 9 Signature

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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 bestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. / tt MYCDt'P c,1it 1t, 2 Print Name of Owner Signature Date

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

The requirements of the Asbestos Control Program Rules may not be lawfully avoiaea or tessenea through the performance of work in Incremental or piecemeal fashion. X:P7 u2001

NYC-WTC 000128119