Invoice for roof work at 15 Dutch Street, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler l E5L NL _ NYS DEC Permit # P .! — 42 Tel.# (1 522-226 3

Disposal Sites) BLUE R~Q E LAr130 Ft LL PO BOX 399 SC.OTSPALE , PA i'7254 _

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) y a) ❑ Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair C9 Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application , 30. LOCATIONS OF ABATEMENT coOt M AT EW A L . tr-Gv - -

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 boiler room, lobby. etc) ducts, storage tanks, deckirm, etc.) FEET FEET removing and replacing boilers, etc.)

FACADE 1`AS51 'FACADE 6 804

FACADE (4E5 i-hCADE W1►5D(SIe IOSO OULK I4EA.t ROOF BULK 1.(EADS RcoF Sc____ . 3 ZG tt A/C UtfITS 2oO /u3At_ts 4 \ p PARAPET t ttcD6r~S 351

31. 1 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.

13 /C(/R2/3,4 J oar/ Print Name of Air Monitor Prin ame of Asbe s ntractor Print Name of Applicant (If other than Owner)

Signature Sin ure Signature

Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance air Control Program Rules. I have contracted the third party the asbestos abatement activities in accordance with the Asbestos the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized filing of this notification for the work specified herein. L Z _ Signature Date Print Name of Owner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE to the NYC DEP ACP.III Any modification of information provided on this form must be reported immediately in writing directly The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throw h the erformance of work in incremental or iecemeal fashion. Ac

NYC-WTC 000130801