Invoice for environmental services, 102-104 Fulton Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IE51L NG___ —__ NYS DEC Permit # -462 —_ Tel.# ('tta) 522-2263

Disposal Site(s) aLue R►D~e— LM~o rtLL Po Sox 399 SCOTS DACE PA IT254 _ ; . .. 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) 0 Fireproofing Replacement f) © Other (Describe) _-- — --~----- -

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

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

Iv. I .

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, installing fire sprinklers, (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum FEET ' FEET removing and replacing boilers, etc.) boiler room, lobby, etc) ducts, storage tanks, decking, etc.) A+t FACADE SJ2 FACES F cE N otzf FACADE. SJ Facc

with Federal, 31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar State and NYC laws and regulations applicable to asbestos related work.

{l1AIM2~ETJ PANZC6 {p 425 B. iCuR2f3AN4 SON CCNt1zcL tN(. Print Name of Air Monitor Print ame of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

or -(9.--c2. rT-t9-2 Date Date Date

for the performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible Asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance with the authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. _ Date Print Name of Owner Signature THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT

avoldea or lessenea The requirements of the Asbestos Control Program Rules may not be lawfully through the performance of work in incremental or piecemeal fashion. ACP7 212001

NYC-WTC 000128660