Invoice for Benjamin Kurzban & Son, 78 Dutch Street, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler _I S (_,_ N 9 _ __— NYS DEC Permit # 111- GT4 __ Tel.# ( 1 ('8) 522— 2263

Disposal Site(s) BLJE YA PGE. LAI D FI LL P.0 ft Y 399 S6Drr DALE 'PA (125.4

27. This asbestos abatement is part of a (Item a through e 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) __ —_--- _--_

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

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

30. LOCATIONS OF ABATEMENT MP~zlci - p-t : 12 Ot AMEN iBRAt'E- DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts, storage tanks, decking, etc.) FEET ' FEET removing and replacing boilers, etc.)

2oOF PCOF Su¢r"Ace l F3~0 U PARAPET WALLS 4 LIEDC-= 490 It QUL.K 0E-AD'S __ ►2~ 525 I, cocf 4 /c ors '700 FACADE L= -r FAeaD E I'32O %t %AST '~Ac,APe I320 II ESCA r s CALL '82 0

LAC- Alt_ SIwrE12S 390

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 nitOr Pri 1 Name sbe os Contractor Print Name of Applicant (If other than Owner) NZi

S nature Sin lure Signature

Date Date Date

32. 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 involy e a estos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. peP a Ib5lo2. Print Name of Owner Signature Date

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

[Kny 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 J1 through the performance of work in incremental or piecemeal fashion. Acai 2!2001 .."

NYC-WTC 000130756