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HomeMy WebLinkAbout096.05-01-19.000 12/2021 „its A,A _ Ci\)\) ta\ ba\ick �� T��o SCANNED 0 r z 1 829r. TOWN OF CORTLANDVILLE • 3577 Terrace Road, Cortland NY 13045 607-756-7490 ( 1em&tiiôvi) / BUILD! PERMIT APPLICATION Fee Paid: ��/7 /�.., — Permit No. 6 24 /1 Application Date: b 1 � Tax ap No. 9t,05-0/ —6,560 Name of Property Owner: Phone CC0 -I B Co- 3`7 Co a p Y Mailing Address& Email Address: 1,.t U : Cp,nm -k-CS2 . . `QE c \t \3R50 Application is Hereby Made to (construct, add, modify,etc.) ' ,-.0- oiQl S .Ltco o - at (address) \\\�J •R0u \r. i C,C4 & O; 1 i•e Number of Family Units Basement? Area (SF) First Floor Area (SF) Second Floor Area (SF) Total Area above Second Floor(SF) Size of Building Size of Lot Setbacks: Front Rear Left Side Right Side Sewage Disposal Water Supply Type of Heat Date of Health Department Approval Builder's Name: \ R cOuQ, C < Phone Number: C(_00 1 59a-a 6 Estimated Cost: OCC Class: ( I Submit drawings showing the location of the building on the lot in relation to the property lines. A set of Building Plans detailing: the foundation, framing, grade and species of lumber, Energy Code Compliance, sheathing, interior walls, stairs, windows and other information that may be necessary to determine compliance with the N.Y.S. Building Codes. All Statements contained herein are true and the work will be performed in the manner set forth in this application in accordance with all codes of the State of New York and all laws, ordinances, codes and regulations of the Town of Cortlandville, New York. Certificate of Occupancy is required upon occupying the premises. The undersigned grants the Town Building Inspector permission to enter upon the premises at all reasonable times for the purpose.of making necessary inspections. Inspections require 24- hour notice by th pplicant. GOrt 1 'u�0 ` • r /��'( PermiCp ro G G0j- I Signature of Applica � :14/NP-A14:2: Permit DisapprovedoQ�D a gnature of Inspector �� / f�� z� � )‘114 "r\N - T c�ailDate: f J/ '`" �� `�� Signature of Cortlandville Town Clerk .h Lfr• t i 3 s TOWN OF CORTLANDVILLE 607-756-7490 Building Permit # D21-12 Date Issued: 11 /4/2021 This notice, which must be prominently displayed on the property or premises to which it pertains, indicates that a BUILDING PERMIT Has been issued to: LCP GrouD Inc. Permitting: Demo and removal of (24.420 sf) former Willcox Tire and repair center by LCP Group Inc At: 1113 Route 13 All work shall be executed in strict compliance with the permit application, approved plans, the NYS Uniform Fire Prevention and Building Code, and all other laws, rules and regulations, which apply. The building permit does not constitute authority to build in violation of any federal, state or local law or other rule or regulation. Soecial Notes (if anv) : Do not proceed beyond these points until countersigned below by the inspector. Footing before pouring concrete Framing before closina Plumbing before enclosina Insulation inspection Footing before backfill Electrical before enclosing_(BY OTHERS) HVAC before enclosing Final lnspection X Permission is hereby granted to proceed with the work as set forth in the specifications, plans, or statements now on file in this department. Any amendments made to the original plans or specifications must be submitted for approval. Permit Expires: 11/04/2022 J�\ Issuing Officer: Desiree Campbell/ Kevin McMahon 4�oAtuNo�. TOWN OF CORTLANDVILLE wit 607-756-7490 CERTIFICATE OF COMPLIANCE Having complied with the provisions of the Local Laws of the Town of Cortlandville and the NYS Fire Prevention and Building Codes as per application type: Demolition, The below named permit holder is hereby granted this Certificate of Compliance. Ramco Development 408 Commerce Rd. Vestal, NY 13850 96.05-01-19.000 Building Permit # D21-12 Type of Permit: Demolition Issued on: 11/04/2021 Completed on: 04/05/2022 Description of work: Demo and removal of (24,420 sf) former Willcox Tire and repair center by LCP Group Inc By Order of 2ry1� NYS Code Enforcement Officers: Desiree Campbell & Kevin McMahon LCPGROU-01 KLISHM ,�►coRo CERTIFICATE OF LIABILITY INSURANCE UATDA'YYY) � 1 1/v112vzozl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Renee Davidson Insurance Office of America PHONE FAX 31 Lewis Street IAIC. No. at): (607) 338-1242 45213 1 twc. Nol:(607) 754.9797 Suite 201 E-MAIL AD All- renee.davidson@ioausa.com Binghamton, NY 13901 I INSURERISI AFFORDING COVERAGE NAICp I INSURER A: Great Divide Insurance CO1r1DanV 25224 INSURED INSURER B: LCP Group, Inc. INSURER C 450 Commerce Road INSURER D : I Vestal, NY 13850 I INSURER E : I INSURER F : I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E`:CLUSIONS AND CONDITIONS OF SUCH 'OLICIES.'-IMITS SHOWN MAY HAVE BEEN REDUCED BY'AID CLAIMS. ItTpNS TYPE OF INSURANCE ANco SUBDR POLICY NUMBER IPOLICYEFF rMMmon vP LIMITS A TMERCIAL GENERAL LIABILITYEACH OCCURRENCE S 1,000,000I CLAIMSMADE OCCUR ECP01549471-21 41112021 4/112022 PREMISFSOIF.RENmEDn�I S 100,000I MED EXP(Anv one oersonl $ 10,000I PERSONAL& ADV INJURY S 1,000,0001 GEN'L AGGREGATE LIMITAPPLIES PER: I GENERAL AGGREGATE S 2,000,0001 POLICY FPRe FLOC PRODUCTS-COMP/OP AGG 4 2,000,0001 OTHER: 5 I A AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT S 1,000,0001 ANYAUTO BAP2022721.14 41112021 41112022 BODILY INJURY (Per oersonl B I OWNED SCHEDULED X AUTOS ONLY AUTOS BODILY INJURVfPer accident) S I X HIRED X NON-O%r I PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per acadentl S S A UMBRELLA DAB X OCCUR 5,000,000 EACH OCCURRENCE 3 I X EXCESS LIAe I CLAJMS-MADE FFX2026004-14 4/112021 4/1/2022 1 AGGREGATE S 5;000,000I DED I X I RETENTION$ 10,000 S J X A WORKERS COMPENSATION PER OTH. AND EMPLOYERS' LIABILITY I STATUTF FR ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCA2024034.15 411/2021 411/2022 1,000,0001 OFFICER/MEMBER EXCLUDED4 � NIA E.L. EACH ACCIDENT $ (Mantlatory In NH) DISEASE EMPLOYEE S E.L. DISE1,000,0001 If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE -POLICY LIMIT S 1,000,-- A Pollution Liability ECP01549471-21 41112021 4/112022 Each Poll Condition 1,000,000 A Professional Liab ECP01549471-21 41112021 411I2022 Each Claim .1,000,OOOI DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddWonal Remarks Schedule, may be attached if mom space is required) 11I1 RE: Demo permit. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town dville /1 3577 Terrace R (Cortland- NV 13 130dR ACORD 25 (2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW I Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la. Legal Name & Address of Insured (use street address only) 1b. Business Telephone Number of Insured (607)592-2866 LCP Group, Inc. 450 Commerce Road Vestal. NY 13860 Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap -Up Policy) 2. Name and Address of Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Cortlandville 3577 Terrace Rd Cortland, NY 13045 1c. NYS Unemployment Insurance Employer Registration Number of Insured 1d. Federal Employer Identification Number of Insured or Social Security Number 26-4167243 3a. Name of Insurance Carrier Great Divide Insurance Company 3b. Policy Number of Entity Listed in Box 'la" WCA2024034-15 3c. Policy effective period 04/01/2021 to 04/01/2022 3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers Included) ❑X all excluded or certain partnerstofficers excluded. This certifies that the insurance carrier, indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named Insured has the coverage as depicted on this forth. Approved by: Pat Regan -Insurance Office of America (Print name of authorized representative or licensed agent of insurance carrier) i Approved by: [A__"1111/2021 (Signature) (Dale) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 607-754-3500 Please Note: Only insurance carriers and their licensed agents are authorized to issue Forth C-105.2. Insurance brokers are NOT authorized to issue it C-105.2 (9-17) www.wcb.ny.gov Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. The head of a late or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of uch permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or squired by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly bscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-17) REVERSE Y"oac w Compensorkers ation CERTIFICATE OF INSURANCE COVERAGE STATE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW t ! vQj! Q ]16 r 4($f L'T54&JPFPaf t M -U[sPos . 6n6A / Wncin[4sntsf l■ yn4m 6 ! - nb:it& `j kVkn la. Legal Name & Address of Insured (use street address only) 1b. Business Telephone Number of Insured LCP GROUP, INC 607-592-2866 450 COMMERCE ROAD VESTAL, NY 13850 Work Location of Insured (Only required it coverage is specifically limited to certain locations In New York State, i.e., Wrap -Up Policy) 2. Name and Address of Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Cortlandville 3577 Terrace Rd Cortland, NY 13045 1c. Federal Employer Identification Number of Insured or Social Security Number 264167243 3a. Name of Insurance Carder ShelterPoint Life Insurance Company 3b. Policy Number of Entity Listed in Box '1 a" DBL427982 3c. Policy effective period 01/01/2021 to 12/31/2022 4. Policy provides the following benefits: © A. Both disability and paid family leave benefits. rl B. Disability benefits only. ❑ C. Paid family leave benefits only. 5. Policy covers: © A. All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B. Only the following class or classes of employers employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carder referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described abovee..� Date Signed 11/1/2021 By (49pp1i1y/ [(jad4'n; oi4ej YAd§ rAI&O4 O6'rW YtA'tt5.MU onb6([4mtU Wj VA rS I rhMthL Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mai( it directly to the certificate holder. If Box 4B, 4C or 5B is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers' Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. t ! wty sl �h Ls r t> Jj(§f Udi§ b b{ i ci#rY4 EffljZm0&m . Gild [h iiii-. ti j one a2t Ar6i LVt L'ssx r 11$f y State of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above -named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By Telephone Number Name and Title [11041t.V 1 O6httt bd( r d*rt4.jrx.tAG6...At 90,,VUsi Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carders are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 11111111uum111111EIIIIII III DB- 120. 1 (10-17) I'I A GROUP, Inc. WE Asbestos Inspection of- 1113 Route 13 Cortlandville, NY Prepared by: Christina Pierce Asbestos Inspector LCP Group, Inc. Issue Date: 7/19/2021 450 Commerce Road Vestal, NY 13850 www.Icoarouo.net (607) 592-2866 ®1� (1/4I'• ROUP, Inc. ®■ Introduction LCP Group was retained to perform a pre -demolition asbestos inspection of the referenced property. In addition to reviewing this report, the following information sources are suggested for reference to all applicable federal, state and local rules, laws and regulations regarding the handling and treatment of asbestos containing building materials (ACBM). * New York State Department of,Labor Industrial Code Rule 56-2.1 Table I and 5.1 (12 NYCRR 56) * United States Environmental Protection Agency (USEPA) 40 CFR 61 National Emission Standards for Hazardous Air Pollutants (NESHAPS) * Occupational Safety and Health Administration (OSHA) Code of Federal Regulations Title 29 Sections 1910.1001 General Industry Standard For Asbestos, 1910.1200 Hazard Communication, 1910.134 General Industry Standard For Respiratory Protection, 1910.145 Specification For Accident Prevention Signs And Tags, 1926.38 Emergency Procedures) 1926.58 General Construction Industry Asbestos Standard, 1926.1101 Construction Industry Standard for Asbestos. * USEPA rule 40 CFR 763.46 Asbestos Hazard Emergency Response Act (AHERA). Purpose The purpose of the asbestos inspection was to identify and quantify the types of asbestos containing building materials (ACBM) in the areas identified by the owner's representative. Samples of the suspect materials were collected and submitted to an independent laboratory for analysis. The condition of each material was noted in relation to its potential to be disturbed during normal operations. The potential for fiber release was also considered. The report is generated for the exclusive use of the customer and/or representatives or agents and documents the inspection work, sampling and analysis performed. The report is not designed to serve as a specification for abatement. 450 Commerce Road Vestal, NY 13850 www.lcouroumnet (607) 592-2866 NIMIMM 'I'I' GROUP, Inc. Methodology for Inspection All work performed by LCP Group was conducted in accordance with applicable regulations including New York State Department of Labor standards 12 NYCRR Part 56, National Emission Standards for Hazardous Air Pollutants (NESHAPS), and Occupational Safety and Health Administration regulations 29 CFR 1910.1101 and 29 CFR 1910.134. A11,LCP Group personnel assigned to conduct inspections have completed the Environmental Protection Agency (EPA) required training and New York State Department of Labor Division of Safety and Health certification program. Techniques used for sample collection were designed to minimize damage to suspected areas, reduce any potential for fiber release, and ensure the safety of the sampling team and building occupants. Samples were collected by LCP Group using the following procedures: 1. The surface to be sampled was sprayed with amended water (detergent and water) as necessary. 2. A plastic sample bag was held to the surface sampled. 3. The sample was collected using tools appropriate to the friability of the material sampled. 4. Sample bags were labeled with a unique material and sample identification number 5. Samples were recorded on a Chain of Custody form, and submitted under strict chain - of -custody procedures to an ELAP and NYSDOH approved and certified laboratory for analysis. 6. Samples were first analyzed using Polarized Light Microscopy (PLM) in accordance with US Environmental Protection Agency Interim Method, 40 CFR Part 763, Supt F, App A (701087). For the sample results not considered definitive (less than or at 1.05 asbestos by weight), additional analysis was performed under Transmission Electron Microscopy (TEM) in accordance with NYS DOH ELAP Item # 198.4, for Non -friable Organically Bound Bulk Material (NOB). The results of this analysis confirmed whether or not a suspect material actually contained asbestos. 450 Commerce Road Vestal, NY 13850 www.lcoerouo.net (607) 592-2866 ®44 11,A] PGROUP, Inc. General Conditions of Inspection 1. The results of the laboratory analytical reports that may be contained herein are the product of the knowledge, experience and expertise of the laboratory retained to perform such services. The consultant neither accepts nor implies any liability for the sample analysis reports. 2. LCP Group neither accepts nor implies any liability for the implementation of the recommendations found within this report. 3. LCP Group cannot be held responsible or liable for the misrepresentation of fact, misstatements or withholding of relevant information by those parties interviewed during this inspection. 4. All observed materials that were suspected to contain asbestos were sampled and analyzed. Materials that may have been inaccessible during the inspection may be present. If suspect materials appear during renovation or demolition, they should be tested and analyzed. LCP is not liable for the presence of materials that may have been hidden or inaccessible during the course of the inspection. 5. This report is based on the condition and contents present at the site on the day of the inspection. LCP is not liable for materials, chemicals or other substances of concern that may have been removed from the site, cleaned or disposed of prior to the inspection date or subsequent to that date. 450 Commerce Road Vestal, NY 13850 wwsv.lcoarotm.net (607) 592-2866 ®� I II 'Ac r' GROUP, Inc. Asbestos Survey Fact Sheet Name and Address of Buildine/Structure 1113 Route 13 Cortlandville, NY Name and Contact Information of Partv Requesting Asbestos Survev Justin Marchuska Marchuska Brothers Justin.marchuska(.marchuskabrothers.com Name of the Firm & Person Conducting the Survev LCP Group (DOL License Number 46632) 450 Commerce Road Vestal, NY 13850 Christina Pierce 0801058 Name of the Laboratory Performing the Analvsis (as annlicable) Amerisci 117 East 30th Street New York, NY 10016 NY Lab ID: 11480EPA Lab Code: NY01378 Asbestos Findings Asbestos containing materials: Transite wall board, approximately 9 sgft, in entry to basement All other non -friable materials presumed to contain asbestos. Non asbestos materials: All friable materials sampled tested negative for asbestos. 450 Commerce Road Vestal, NY 13850 w%vivIcneroun.net (607) 592-2866 rRelinquished By: 1 !C" - DatelTimo: 6 J`✓(� J ^'` BULK SAMPLE SHEET STReCT 1 Received By. O - - _ DateJTime•_.(y.�.j't2 r�fKb ` 117Ensr 30'r AMr<RrScr Ntw Yolut,NY10016 10016 Relinquished By: Datet7imv: ± / TOLL F6EE(800) 7055227 ' DatelTimv) Fax(212 679-3114 : � _ . i '. �M[G5CIJaBa; Cmnpany: a LCP Group, i 1 - ,t Street Address: 633 Anderson Road ProjecYAdtlreas: ��,j",�_ v`'.Ci.`ti,SJ�4.; Stir �,l �' �[enl Project 9 City: Vestal, ana9caNro _ _r. Analysis: _PLId Ovly _TEMOnly L�'NYELAP PLMrtEM (596.1/t98.8)798,4{ Phone:' 607 592.2866 Fax: 607 J48.1465 I ASTM Dust(Mw?gvac) _ASTM Dust(Wipo), ,_Other(deswhcMcomments) Fax ME -Mail: Icpgrcup@yahoo.com Special instructions or Com�Jmerdw. " �' // Feld ID # , Sample loeaUon c. rr r7F1 � tq:rprca:r.-�- �rv...1.ai 4� I r__ m sh "v1/2�Hr�-24 Hr•�4//877W^t72 Hr,-, SD MaYI Yy�ec.�Bulk Air - - - Water, IBy;( wf�],)tic,�y!'j „/.P _Date Sam pletl:._ pcsilve Stop? i I Sample DescnptioniMaterial Typo. Homogenousun � tordust<$izeotaudaceama_sompledL! Area (HA pI - - I ( ®® MINE -IN o O C C3 �RNlnquishod Sy: 11.�— `�— -`jil.TlfJLL•��tJr:Q/fGr� Date tiima:_(C q �j,_��`j`., �^ BULK SAMPLESHEET - Received By: 'I17 Eas130'"STREET Daterr.. / i(I jq-((,y ;(,LAMERI SCI NEW YORK NY 10016 J u I :Relinquished By:' Daterrime: / Tou FREE (8001705.5227 Received DatolTimo. ,- Fax (212) 679J114 Ccmparry: LCP Greup I ? L8 1-`t jMQ-' 9 i ---• v- -_ Stmet Address: 833 Anderson Road Project Address:,]\\3J 11'�-�w°.wt..�._iC:iL S`i�ffti. Client Project#:_ _ 'city; Vestal State: NYC_ 13850._..Pmject_Manager _ZIP: --i�Analysis: _Pled Only 7EM ONy _ NY FLAP PUNTEtd(198.11196.6f1984) LA�PhenN (6071592-2888 Fax: (607) 348-1466 -. ASTM Dust(Micstr ac) _ASTM Oust (Wipe) _Other (describe in comments) . 5 n SflelSeconda Fax XE-Maih Ic rou ahoo com )------^- ry.. _._.._P9, _ P'�Y_.._: TAT .Rush_,12Nr_,24 Hr___,48 H:,72 HrSDI h1al 1, c Bulk r __ TYP, i_-- r.—Air _Wateri 5 3 < : Christina Pierca .._---, _Sampled Results to _ _ Sam letl ._ BY-s.._C-!h��.._... P.2. _-..-_. . ._. n 3 Spe ^- Instructions or Comments: Positive Stop?.. t7 � Yes No C m 5, 'p i Field ID Sample Location Sample Descdptionisatedal Type I Homogenous' dust- slip of surface area sampledl Ama (tor �� tZ Z _. ti ft._.... Ch a Qe t ii I f jt �S 6` i BULK SAMPLE SHEET Recalled By: + Dato7Tima; ( 117 Ea6130-3pdmT Mf7 -�^ r11�' ` — I =c- '�JAMERISC! NEWYOMNY10016 j RNinqulahed By; OatMTimaa _ ./ TOLL FRCE(800) 705:5227, j Date7rime: �'sy'� Fax (212)6794114' i Company: LCP Oms@��y@ up" - ;ear La L �2 10 / -7 Street Address: 633 Anderson Road Proact,Aaaress_.,it�3 P-- i Ftty:Vestal _ State: NY ZIP_108W:_.TP SELmanager .- ' -•„_ —_-" ip�nalysls:_PLNIOnly TEMOnry NYC" �ELAPPLMRMM(198.11198,51198.4) ^j a i— ASTM Dust(Micmvac) _ASTM Duat(WWe) „ OPW(descdW In comments ! - v, bhono:1607)592_2868 Fax: (60T)048_1d85 ..._-.-. ) SiNJSecanaary Fae 01E-Mail: kpgroup�yaleoo_eMn,—,,,_,�TAT:RuaN_�72_Ht_,24 Hr/ ,dg Hr ,,72 Hr 6D _t'I Type: veulk ��Ilr—We'd,,! "Rac_ . .__._... .... . _ . .puOChristina Pima ted:_.;..._- peclatlnstruwnsoComments:Positive Stop? p _� `Yea Noun m Fkid ID i - '--8amplo L"c'Wn Sample OeacriptioN3latortaiType S Homogenous p ki p 'A j — y,�. .. � {fai Cuat= alza of auRaee ama sampled) Aroa {HAbj P.:'}GY*iinv -�� �}^.-,�_- _._..__• _...�.�. .-. __. Go r aw :_.----'�----.__�tn�:; :'^��'.w'nL:xt�'F:s�'•S_mSs.—. _....._—..- — - _ - _- . _. _, ......._._,. „ t 7 ®® WON No