Invoice from Kurzban & Son Control, Inc., 120 Fulton Street,

NYC 9/11 Public Portal Document %2O s S V ASBESTOS -INSPECTION REPORT (continued)

° 26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718)522-2283 Scotsdale, Pa 17254 Disposal Site(s) BlueRidge Landfill PO Box 399

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of et inpls) b) ❑ Boller Replacement C) 0 Sprinkler Replacement d) ❑ RenovatiorvAiteration a) ❑ Demolition e) 0 Flreproofing Replacement t) El other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair XClean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application fl ' a w •rc o i w A .-••••-.r...-. • - Q1tY'Wr=' I Ac. -- AA Pt" -- - J - ~~~~V --- 7 I~I/'~~/ G•~ U.LWA /Vn0Vr I10M 1GnHG's I 1-s.. .

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING OF FLOOR CONTAINING ACM PERFORMED Floor(s) SQUARE LINEAR (e.g. running cable. Installing Ate sprinklers. (e.g. entire, east wing. room #. (e.g. PIPE lagging, ceiling, plenum ducts. storage tanks. deddng. al FEET • removIng and boilers, etc.) broiler room etc)

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

Print Name of Air Monitor ~' Print me of tractor Print Name of Applicant (If other than Owner)-

Sig Signature Signature

O '7 Date _Date Date

performance of 32. 1 understand that as the owner of a building where asbestos abatement activity occurs. I am responsible for the the asbestos abatement activities In accordance with the Asbestos Control Program Rules. I have contracted the third party air parties Involved lathe asbes project. I hereby declare that I have authorized the monitor who Is completely independent of all filing of this notification for the work specified herein. /...._ _ v_ i__ !02

Print Name of Owner Signature Date SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK PCP. Any modification of information provided on this form must be reported immediately In writing directly to the NYC DEP requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 212001

NYC-WTC 000128929