NYC 9/11 Public Portal Document
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MT. 4/n
DEPARTMENT OF ENVIRONMENTAL PROTEGTiON
EXECUTIVE OFFICES
5947 JUKCnOX BLVD., 19TH FLOOR, CORONA, NEW YORK 11368-5107
JOEL A. MIELE, SR., P.E., commosioksr
NYC PEP (BANHM) ASBESTOS S LEAD CONTROL PROGRAM
OVERTIME AUTHORIZATION FORM
Bureau/Unit: • Location: Tcufelt-
Distribution #: Week Ending: Vir
Weekly Attendance
S M T W TH F s
yo
NORMAL WORK WEEK---- St---------- HOURS
Employee Name: Civil Service Title: SoaALSECURm'#:
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total overtime 5% annual salary in has employee exceeded 5% retirement eligibility
previous 12 monthsi hours---------- — In O.T. ? (yes / no)-------- imonth year
---------- hours 1
I
TIME ALLOCATION std/bv
Location(s) Reason(s) i
Date(s) comp comp pay comp
str. prem. str. pre. hot
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uJiStLA^
yb -V_______
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Report Totpls
Explanation: ' Spsdiy In We space below the reason vby (Ins employee vTts /Ijw salary
Authoir^^ Ap^val Signaturc(s) /
Supervisor Date
Approved Q Disapproved
Bureau Chicf/Commissioncr’s Designee Date
NYC-WTC_000158988
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