Invoice from Kurzban & Son Control, Inc., 122 Fulton Street,

NYC 9/11 Public Portal Document

ASBESTOS INSI ECTION REPORT (continued) 4 °

26. Asbestos Hauler. ! t✓al , tu NYS DEC Permit # --462 Tel.# C-rc8 --2263

Disposal Site(s) s:~-tt>r„v- tf )PI(.L R) BGx 39 SCoorsPw&E YR .I12S4.

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

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application .. . i.n.r.#%.c. nr wsw~rVur&rr 0 ' s .. .. - t?..r_~i 4b1 M SCst..6.r fE C - r^f - ,N

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room 0. (e.g. Pipe lagging, ceiling, plenum SQUARE L (NEAR (e.g. running cable. installing rue sprinklers, boiler room. lobby, etc) ducts. storage tanks. decking, etc) FEET ' FEET removing and replacing boilersetc:

t 94>0t= pta a.ad.- (750 I' t.~.3G7P1..6L 12-O~ mer -At._.

ANP>U~ i -n* t .eta C ) 2400 SaT

t~ACA-VE / -1J tA.1 fc".. S 5G1i 3 es"sc 325 t . tLco~ 5.~taF- A/C k trs _ M i. 000

31. 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.

Print a of Air nor Pr6d o of Asbestos Print Name of Applicant (if other than Owner) j

pdWn..-fps--. ~--•.»

s ignature Signature Signature

t&/o`7i Da Date Date

32. s 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 sbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. i8(o2 „ fi Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

[A ny modification of Information provided on this form must be reported immediately in wilting directly to the NYC DEP ACP. I The reouirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened 212001 ti •

NYC-WTC 000128968