NYC 9/11 Public Portal Document
SEP-12 05 21:20 FROM:DOL ACB 212352692 TO: 718 PAGE: 10
$
E. FEE SCBFDirl(,E
Refer tv Item 17 to calculateyour raqufreddfans. Thisfee is non-refundable. Chock one boxfor ttrtaorfeat and one barfor s4uarvfee,.
18. Fee Schedule: a) Linear feet b) Square feet
❑ 0-259........................_. ($0) ❑ 0-159 ........................... ($0)
❑ 260-429................_.. ($100) ❑ 160-259 ........................ (5/00)
❑ 430 - 824 ._...._._...M..,,» ($200) ❑ 260- 499 ......................... (5200)
❑ 825 -1649.-................. ($300) ❑ 500.999 ........................ ($100)
O 1650 or more _ .. ., ($1000) f:i 1000 or more . .............. ($1000)
19. Total Fee Due for Prgject S 1000.00 . (add 18a and 18b)
Q I F. REMARKS
Ur'e this area toprovide additional lgformatton.
Asbestos Abatement shall be performed utilizing NYC DEP Sub-Chapter G Regulations and site
specific valiance.
All waste shall be double bagged for disposal purposes.
Waste Disposal Site: Meadowftll Landfill, Route 2, Box 68, Bridgeport, WV.
BFI Imperial Landfill- PO Box 47, Route 980 & Boggs Rd., Imperial PA
Cumberland County Landfill - 820 Newville Rd, Newburgh, PA 17242
Waste Hauler/Transporter: DJM, Inc. 109-113 Jacobus Ave., Kearny, NJ 07032
G. SIGNATURE
I certify that the information specified on this notification is true and accurate and that the project will be conducted in
ccmpliangewtth the requirements of9ode Rule 56.
08/11/05
or C dyAuthorised Representative Date
Print Name of the Contractor or Duly Authori ed Representative
see next page for submission Instructions and notification information.
NYC-WTC 000134439
OCR can misread numbers and units. Confirm readings against the page image before using them.