Asbestos removal invoice, 40 Exchange Place, Sep 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) , Asbestos =m 26. Asbestos Hauler Transportation CO NYS DEC Permit 6 i-371 TEL.# 63 '-92 4-5050

DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies Valleyview Dr., PA 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 DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM I 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.)

OOFS Item No. 3 Partial Roofs 13560 Facades Item No. 8 Partial Facades 45500

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.

Warren & Panzer Trio Asbestos Rv1.Crp. N Prin~Namof~A~irMonftor Prir NamaEf Asb Contractor P Na of pp r f Iher than caner)

-Signature

Date (1 S' nature

Date I Signatu e

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 Date

monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. c/o NYC Print Name of Owner Signature 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 ACP7 L through the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000130857