Invoice for work at 112 Fulton Street, Oct 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) C) Tel ^2 26. Asbestos Hauler M'S DEC Permit ~ Disposal Sites) O e2N try e 5 1 ( •

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) ❑ Boiler Replacement c) ❑ sprinkler Replacement . d) 0 RenovationlAlteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) 4 ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent 0 DEP Variance Application jJ~ 30. LOCATIONS OF ABATEMENT - #v Z DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g entire, east wing. room I. (e.g. Pipe tagging, ceiling, plenum OUARE (e.g. ing cable, inslaning tire sa*+ s. boiler room lobby, etc) duds. storage tanks. deddng. etc.) FEET • FEET ra novsng and iepladn boilers. etc.)

Re s

31. t 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.

Print itor Name d Contractor Print Nam of App nt (H other than Owner)

Sgnature nature Signature

Date Date Date

32. t 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 thereby declare that I have authorized the filing of this notification for the work specified herein. + lfiJJ 9 Cy Prau Name of owner Sipnsttxe 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. ~cnt

NYC-WTC 000128774