NYC 9/11 Public Portal Document
A r arZlH.-------- DEPARTMENT OF EN5'TRONMENTAL PROTECTION
B
" ••Kj
EXXCUnVE OFFICES
S9:17JUMCnOX BLVD^ 19TH FLOOR, COROXA, NEW YORK 11368-5107
,JGEL A'/MIELE, sr., P.E., COSZMSSIOKER
KYC PEg (BANHM) ASBESTOS C MWiD CX3NTROL PROGRAM
OVERTIME AUTHORIZATION FORM
Bureau/Unit: ' ' Location:
Distribution #: Week Ending:
Weekly Attendance
A 4- M T . W TH
*7
F S
NORMAL WORK WEEK 4IOURS
Ml • J Employ^ Name: Cmt Serstce Title: SOOAL Security#:
HI
total overtime 5% annual salary in has employee exceeded 5%^ ' . retirement eligibility'
previous 12 months hours ... in O.T. 7 (yes Z no)--------- month year
——— hours
Tut E ALLOCATION 2^
Date(s) Location(s) Reason(s)
comp comp pay comp
str. prem. str. pre. hot.
n
Report Totals, r
M?(ExpIan£tion£;;j£S£?a(y7irtlic2pa£<Hclow2he^^ ccssbf5% of hisHier salary^?
Authorized & Approval Signalurc(s)
Supervisor / Date
_
Bureau Chicf/Commissioncr’s Designee Appro' cd Disapproved Date
NYC-WTC_000158982
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