Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MP17-035
O��yvr V Jy� r . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 22,2023 Frank Carpiniello&Anna Carpiniello 172 Ivy Hill Lane Rye Brook,New York 10573 Re: 172 Ivy Hill Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-41 As per the Certification letter from Mike Hoensch Tank Company Inc. dated August 18,2023,the removal of an underground oil tank and installation of a new underground oil tank under Mechanical Permit #17-035 issued on 5/1/2017 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BR(��. 1982• BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:— DATE: _ I PERMIT# � �� ISSUED: ` l I-� SECT: BLOCK: LOT: LOCATION: 1 p n i "�� � , f' S �� t' OCCUPANCY: ❑ Violation Noted THE WORK IS... a-O'PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER -BRo°� o ti w � BUILDING DEPARTMENT 0 BUILDING INSPECTOR VILLAGE OF RYE BROOK 0 VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: -�- l �- ATE: 11 -� r PERMIT# • 1� ISSUED: SECT: LOCK: LOT: - l LOCATION: (;� OCCUPANCY: 1 ❑ VIOLATION NOTED THE WORK IS... ❑ ACCFPTED REJECTED/REINSPECTION 0 SITE INSPECTION REQUIRED ❑ FOOTING 0 FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING0 INSULATION ` ❑ NATURAL GAS L J�1 1 AaC1 1` V'�� '1 (�1' ��QC,�- �'1 ❑ L.P. GAS ' ��.r ,Zo i lQ 0 FUEL TANK ❑ FIRE SPRINKLERnQ a Q 0 FINAL PLUMBING `` 1,NQ `' � - U" 0 FINAL ❑ OTHER �yE � m 9a BUILDING DEPARTMENT ❑Bunmmo INsmcrolt VILLAGE OF RYE BROOK ❑W.LWE ENGNNM 938 KING STREET RYE BROOK,NY 10573 t�ASSWANT BUHMI Na INSPWMR (914)939-0668 FAx(914)939-5801 3 - -- -- - - -- - --- -- --- - - - INSPECTION REPORT -----------'-"--- ------ ADDRESS: ' a y � `J)) � >ATi: PERMIT# r1 /-" I3sm.. SECT: BLOW. LOT: LOCATION: C OCCUPANCY: 0 VIOLATION NOTED THE WORK IS... ❑ ACCEPT ❑ REJECTED i REINSPECTION 0 SITE INSPECIION REQUIRED 0 FOOTM 0 FOOTING DRAINAGE 0 FOUNDATION p UNDERGROUND PLUMBING NOTES ON INSPECTION: b ROUGHPLUMBM 1 1 n 0 ROUGH FRAMIING Ohm 4d Gl ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ,c�.Y P C�' FUEL TANK `'� °i N U 40 i" S ❑ FutE SpRna im ; ❑ FIINAL PLUIu Bm 0 FANAL V ryS 5i p / Tank Check List Survey Date: I�I�5 Tech Referral: Lead#: ?DI s6 9 57- Date Sold:_ Sales Rep.: / Installation Date: Customer Name +�G�. �L 3��� t �[ 6 _ Acet#: �U� 7 ?y Address: ��� �( ✓ Cross streeUlandmark:� P�U`--s Home phone4M 6 r-- `�'rrwAlternate phone: Existing Tank Size: Gallons Remaining: d C �J Location: Basement: Garage: Underground: Crawl Space Other(location): ProGuard Yes No Method of Abandonment: Foam Sand Slurry Removal If removal is cutting required? Y_N_Z If yes, number of cuts New Tank Size: 275 330 550 1,Oo0 Other Type: Steel Roth Fiberglass Location: Basement: Garage: Underground: s'� Crawi Space Other(location): Concrete slab required?Y N��Collision Poles Required?Y N -� If yes, how many? Tank Shed Required? Y Nam"dank Tub Required? Y N_� If tank tub what color? White Med. Grey Dark Green Two Tone Beige Is oil line accessible? Y N '� #of feet of new oil line required (in addition to 10' included): Run oil line in 1 pipe_or 2 pipe . Run lines overhead?Y N If new oil lines can not be run explain why: Masonry chop required?Y N / Distance Location If yes, driveway walkway floor foundation How many square feet? Trenching required?Y' N It yes, how many feet? Install new 2" I.P.S. vent pipe complete with 2"x 2"vent alarm: Y N Install new 2" I.P.S. fill pipe complete with Petro approved fill box: Y N Pump out tank required Y-,-, Special instructions (difficult access): i 6 C'4t � Tank Location Survey Appliance Location: _ Pi6tures Basement— Bil.co/Hatch_ Walk-in—Kitchen` Mandatory: Garage_ Requires blocks_,Lolly columns_ 1. Appliance being removed 1st Floor_ Stairs_ Walk-in 2. Obstacles Outside—Landscape Optional: Other: 1, Entrance& Exit Access: 2 Stairs Driveway condition: Good ir_Poor_ 3. Floors, rugs, etc. Door(s)condition: Good!Fair—Poor 4. Others as needed Size of door opening: Can door(s) be removed: Yes No� Stairs: Outside Construction material Condition:Good W Fair—Poor Are back of stairs visible:Yes—No— Condition of stair support: Good—Fair—Poor— Inside— Construction material Condition: Good—Fair—Poor,Width—Turns— Are back of stairs visible:Yes—No— Condition of stair support: Good Fair—Poor— Preexisting damages (if yes provide pictures) Lea O= Old Tank N = New Tank 1 W= Water Main G = Gas Main S= Sewer Line E= Electrical H= Boiler/Fumace/HWH IS= Inground Sprinkler Line I r i I y , AONO ..w...� � �ryr 1C1!frl(� lfrr r uTo'J^ z� ���iii,,,,�..,, � e�- •fir I�� - 6er ti fAAX������111t111ppp���'` ,� ,��t� C.'y,X �'�' Aw .�f� `� a �`cP' ,e i•1 }�� `�.R� x ' o{``�, w. s!'r, ��,�1f'!•.Nr i :'-'O•"'y�'ab"��� 7'q1 {,�,h {�`��''� 'r �r t.s„' t - � �. SvP,r +Pi` ar4 :+ Ar+'2 j��v .;+t rp•i�- :s. 2" II' vy ryw.,: i+ .OY j�j f �r �� ,K'�YN�1�` � yvll��^��i�.c p f 3� 1 �`' '� 1y. 't .c� !•Y '�"�'Mc.. •� 1 4 ,,,,r `` � µ:.. '. �, }.r ;�rK•,Y. A'•� ':.r � V' SJ. ` �j ..e"P� 1 T'�T�,`i ° y•,i•,M RR+ Y. l,q i .t Q,^i...� n ,fir _ �• �^R. ; RINI .r _ •y. *'•Y k1 `C. ,.�"��rt:• 4r ��Ntn* ;• M1"s', �.�� �j��U A' � fib p.. Yi. ��� � ,cr/F-,s '1r4, � �./'� 1.� i}��,p �' `�'�W � � •� �` � r � +; a 4"T Y'�" Yt�,.y�j •' y�k sell..Y �n w It,, ♦j�, y. "II.Py "F - ,. .' wl jsalu C i- A ys . , ' o w Y Yf� '" 10 -4-141. ,(s3,•V--+ fff°p=w it ice" I ..A„'h I.1Aa� • •1 � ` r .A �, rr SA' yr A'f 4"1( e'�f ti• A y7iY �T p r r,�,fh,,.l�te /�I." ,�: (,sd, l:�t�� � SIf.,��►�.�. R. 1 a��r�[� _ S. r d, ^•a f°' .� ��({ ir�ej' •'A, 'elIrl + d' �x. K:• Is r- v Ir-Icl �i4jr�lr A7/ YiFic✓I �p `�' ., ; prily�� n,x;a r vi4 1 S10.+" w �`� y` r''0, {d`hy;M I 1 f l!, {{' '�.! 7! r ` r- a/,• rr,'� 0' r.,• v ^I f yr ���� v` c�+a'• sr^ v - 1' ifA s i, `RF. J'f y�,: r M ` +p► df . r r sei F`' rt^ • v�. .�k p ' 'g!, tE. a.ram.. � *, rl r `+, '�9f r lFg�„ aye r rd c i t`� ` •!•.1? �C'. r ti , f 3 J 4 b y 9 w'� r G � �ba , •1� ,h F�. q, flp a vac 4.� a ��r}, rrp' i ,'. 7r� • a, • J -r /a .. � � „IP �.. .�,� ��e`4tl � ,Y � v; rr i17` '., r� , �.� .�. e', a ,� 1 �.� �� d�� ✓r'�'`t sy w '� � 7 it ,' �4�� �q �^,Y �•. 'p * !� t,-( � � i�q�M fi/ t wb �r�y '� 'p hr p pI a `�->! - h�. Apr f 'aqw ,,�Zt '�• a�'� Sw", !^a ��Y'�l,�pe�y Ir /��S - � � � t' r'y$rt I,�.11 i��t�r,Y� �•� 4.� � +�t�i •/`} , , IIAY]7"«4�4j v�� I�'%�.•{� �� . �Ye�I.'�, ��p .�� �'...�irr ...rT��� , ,� �,/�' i'''�N J. sR � ^Na' 4i }r,� •r ..sa1,r+C�,'��nF ,p gl •w.i /; �. �',�.,,3 �/JA � e fib, �W+rIBr•�:.?�'tI', �. "�'1� I� !. ''y4r !�" �% i. •,�, ~s,.i� A rxN cy�� 1 �1 � $.y�°,1r��>i � i ep,r � •y ��i �f � � .��rl�r�'r�1 d►"A w a�i {i� y"� i�^�'��',`` ��f ,r '• .11 a,. t CCr1 i v���,s• �+�� ,k���� `�' ;,,,��/���'f'''t�'�.',r�,,.4'�'�'��..,,>,,,���ii, ak -r;,�,, �. � r. r ' �fl' ly�r ;�YP �'�t A'Y�".•'�Tw 'y���'ib:I:�:�,1,�1�`�'•ta Y'', a � � 'err • "7".t• � .Y �.�+{ -�';J�� y ��.�'•e�S� SY;����y� 'fie �'rf,l' r �,p�,e-' ;M�'+s �. e .:� '.�:'.gjrye> `\�j >• Y,�V;ti' f r••I„P., r+ X� ""•it f� �I,�^.N C� r •',�_ > ,i. �!. Per+4y;.%�, �� y � i, 1'•y."i f a l�'+,�' „r:' n;Ark ,. �,' _ � •< •.t It '}vy,L�1' ,v.} BiCr t` „1.-'fL+fin. t .. A:.: '^�'•P if++� .k,:• 1'�. A„• ',tL�: - }x`t' _ "F4t'� r"C.• c_r „s, < .:w '. +�'•F O + gn ON W .�j. � .3�. •• �. fes , � ..r �:, .. `,�f _�"".� :�.'� .,,5�,�.'YW:.. r '4�-ar f�-:: a�p-y, y�•v �y'sa. i " SST r $ °l� -,. �.v ,•m~ 1'' Y'��`Z#�"L L� '.,,�`�.� 't..S2!`: �• > - _�� ��TS���+l,j� bf ".4 ��':sF- �.,.. ?i i 3L•�W' K � y j�.����,+. I �0 w�-4,.V a _ 1 ` f i I AA e � f r.. po %7 'a�li°r .� A.'ti ry r° r r' r_ ■ + s .! 4 ! +HV 1 1 ry Fvi rS h� y . T� * ~'+ s s 1 �f` • 1 re, e I • yp •l ` ? e :r ti� S►. �F� �R� i may, Ir f If '• �,'� •e,� �,' a'�(" } e.,+'_•.4:,=�1 a � / ..i •�9` 1��.•+• 'y-'�i• e•.��`e�'' e f , •re e'�� ,��j ��� Lip .•' e '+ r • �; • 1 * Jyil► t*�k � {rr* . 'I.*r�`e ai 1 tie , CS ',r M +? " i - s f. •,"ia! �.ia�{w �Ge'. ii!. > !*• ° tr:J4+` },a1M qr •7~ ;'• -�•' '. SIr.Ate y,,-��'�1 �';. -h' 4� � '',� �,,��ti' �-�''.' >tl�,t ,/fir ��y'r�: 1 ., �■A7��ree `��� ..�° �e y � ..r.+Y_.� •,.r e r + °�, r � �a a, ', .�-'7 �i'�!'�I.7� ` ,y fir'``.J j� �� •�.�."� �'�„ tti. .� "7 1�k �1x�`�, �... �,y,``. + ar.y�l�r+ye ae",ti �1+ A � ',�� kv.f�*;y,I s ¢r y_ye e k�t*tM.,+•• '.• !�j ! • u� �Y+.}rr.9.k 1� .el" A �'°r`• ` A; -17!. `� •So �. .. ;4�I+1�•. •A"'�aLr'ef;�'L � �'� rr b S.^�+' � _",=i3' ,�djFp� i r'r� ? ��� `.1e� � .�• "�' y-i+ '�f!.f�, = *�°J�1 `tirCrrF f � }L~; �,� r r .. .� '+e =�°; ''�- 4• ♦1�:. . IFs,•.. �..+ y�y•.r API l '=•� '�+ t'.>r . . rw �i,*`4S •I�r-7r.'� .y'i4 . w, J, .�� •+ 11' JfPA �Tti:�.r r ••'d. �.r !' ,+-"�'�.�:` J;i lh,� •+ �,, dlr,r,`•#~�'�1 r'1A,�tti y'±• •i�` -\ �, '* *1" .r L..,�•,�A}t3 �"+', }��. ,� b��;+! Awl+ � ' r, Jr • .f �.. e .5 - • 11. ► `. j'dM;.A•" + 1 } �;r�tid'A '1..! „�./ lit.' 'J� it •�q�Y_ .+! i,eer +•►'..•. r, rt�^' �.�, •�.. ti ,,s ��•�r:.rJ'.�I��r� � `+e pi fe. •' � ° �•` !-� � .J, a �� •. .1 lr•11 `� 1j a•. Jar' ••i+%. _ „ .-° _ �} y,- • �Yy_S ., ` ,5 p.' � `� c a�.`�. o � J •..,•f.. rt�•� iF�- rl ri 4"ed e /,•J r4 '1 •r` *.. j �.. 1 xr • A Wes AA- 5 _{;, �+ �• may. ae +e. a z Laura Petersen From: Steven Fews Sent: Monday, August 7, 2023 4:36 PM To: James Carpiniello Cc: Laura Petersen Subject: RE: 172 Ivy Hill Lane, Rye Brook NY - Open Permit for Oil Tank Replacement Expires: Tuesday, December 5, 2023 12:00 AM Ok, le me know when they remediate. I will speak to Laura tomorrow about the other outstanding permit Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914)939-0668 From:James Carpiniello<jimcarplaw@gmail.com> Sent: Friday,August 4, 2023 11:38 AM To:Steven Fews<Steve Fews@ rye broo k.o rg> Subject: Re: 172 Ivy Hill Lane, Rye Brook NY-Open Permit for Oil Tank Replacement Hi Steve, My father measured the fill and vent pipes and they were standing at about 14". 1 don't know whether that would satisfy your code's requirements. Petro Home services is doing an annual inspection today and I have alerted them to the fact that their installation did not pass inspection. Hopefully they will be able ro remediate. Meanwhile,the 1998 tank replacement permit is still open. Are you able to close that based upon the town document stating it passed inspection? Since the tank has since been replaced again, I doubt there would be anything left to inspect. Thanks, Jim On Thu,Aug 3, 2023 at 10:57 AM James Carpiniello<jimcarplaw@gmail.com>wrote: Will do,thank you. On Thu, Aug 3, 2023 at 9:10 AM Steven Fews<SteveFews@rvebrook.org>wrote: Good Morning, you can go in the yard where the tank is and check it out. If it hasn't been resolved you will need to contact the Tank company to come out and make corrections.Then call us here in the office to schedule a re-inspection. Thank You. 1 Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 From:James Carpiniello <jimcarplaw@gmail.com> Sent:Thursday,August 3, 2023 7:16 AM To: Steven Fews<SteveFews@ rye brook.org> Subject: Re: 172 Ivy Hill Lane, Rye Brook NY- Open Permit for Oil Tank Replacement I see. I don't know whether these problems were fixed. Now what do we do? On Wed, Aug 2, 2023 at 4:58 PM Steven Fews<SteveFews@ryebrook.org>wrote: Good Afternoon, I found this in the files. This is the last report that shows why the new tank failed inspection. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 From:James Carpiniello <jimcarplaw@gmail.com> Sent: Wednesday, August 2, 2023 3:03 PM To: Steven Fews <SteveFews@ryebrook.org> Subject: Re: 172 Ivy Hill Lane, Rye Brook NY-Open Permit for Oil Tank Replacement Yes, the new one is. On Wed, Aug 2, 2023 at 3:00 PM Steven Fews<Steve Fews@ rye b roo k.org>wrote: 2 . Good Afternoon, the second attached group of documents, shows that a permit was taken out in 5/1/2017 to remove the old 500 gallon underground storage tank,and then install a new 550 underground oil storage tank in its place.There is no Building Inspector report for that work,to testify that it was ever inspected. Is that tank still there? Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914)939-0668 From:James Carpiniello<iimcarplawPgmail.com> Sent:Wednesday,August 2, 2023 11:55 AM To:Steven Fews<SteveFews@ryebrook.org> Subject: 172 Ivy Hill Lane, Rye Brook NY-Open Permit for Oil Tank Replacement Hi Steve, First of all, I misspoke- it was 1998, not 1979. Please see the attached PDFs. Pages 26-30 of the Title Report doc shows the information pertaining to the permit. Page 28 shows that it was inspected by the building department and "passed" is checked. The other doc contains soil test lab reports and other info. Please let me know if you need anything else from me in order to close the permit. Thanks Jim James R. Carpiniello, Esq., (914)275-8434 Confidentiality and Liability Notification: E-mail transmissions cannot be guaranteed secure or error-free, as information could be intercepted, corrupted, lost, destroyed, delayed or incomplete.The sender therefore, does not 3 �Q V/ IE AUG 18 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT t _ � Mike Hoensch Tank Company Inc. New York: PO Box 428 Warwick, NY 10990 • New Jersey: PO Box 576 Hewitt, NJ 07421 MJTel: 973.390.5356 • MY Tel: 843.544.2330 • Fox: 845.544.1789 web: www.MHTankco.com • E-mail: MHTankco@yahoo.com 8/18/2023 RE: Frank Carpiniello 172 Ivy Hill Lane Ryebrook,NY To Whom It May Concern; I am writing this letter to indicate that MH Tank Co. removed (1)500 gallon underground oil tank from the above address under permit#MP17-035. The tank was removed on 6/20/2017. There was no evidence of tank failure found. Respectfully is ael J. Hoensch President Mike Hoensch Tank Company Inc. Oct 03 17 04:33p MH TANK CO 8455441789 p.1 Mike Hoensch Tank Company Inc. New York: PO Box 428 Warwick, NY 10990 • New Jersey: PO Box 576 Hewitt, NJ 07421 NJTel: 973.390.S3S6 • NY Tel: 845.544.2330 • Fax: 84S.S44.1789 web: www.MHTankca.com • E-mail: MHTankco@yahoo.com DRp C� � �MC COVER LETTER OCT 10 2017 0 VILLAGE OF RYE BROOK DATE: b 3 17 BUILDING DEPARTMENT TO: V FAX #: 1 la.— O FROM: TRACI BRUNO RE: J 1�1 — 1 7 — O'�5 1 —7 ._L_vim"LT a 1 # OF PAGES INCLUDING COVER SHEET: Oct 03 17 04:34p MH TANK CO 8455441789 p.2 PA(,AHf EWOT�HW-M 0.I,�, All State O�R,r .inc. DEP# S6001 SIJA-399 473 Hainburg Tyke, 1 SPA 4•NJD 986598630 Wsst Milford,N-J, 171480 C'�9f0�AEit8OMURNO, PHONE DA /7 1 NAB IV YARD WE-OUP YARf�i lhrlFr ii1 IN 0lJT Ctl?6aF1EPt{I7N dH�oF�# A�rtORT EkJt: - Q �SRATDFfi� f i � 11f�ANIFivB'i'# ' ' 3 MINER NAME E #1 Q4 VAC TR, e I 06 RACI9 TRUCK 07 IM 9 GARf3iER r. WASTE t� ORff'TION 30 q aaw'5o i/ wadi✓ AJO. RI~CEIV TOTAL[ win • J.rrr IJi-fY�I�I�N Oct 03 17 04:34p MH TANK CO 8455441789 p.3 .Slading Forest,NY J'09- is s -7?•-0792i - l-7�. �✓ Ctz.� e2 �g /VIV DIM." r�� CUNT �s Pos; -L OF/, a 50 o #LLOA) you �a4ca Chess payable 4o Lecay sum HP Offlcejet Pro X478dw MFP Series Fax Log for MH TANK CO 8455441789 Oct 03 2017 4:35PM Last Transaction Date Time Type Station ID Duration Pages Result Di ital Fax Oct 3 4:33PM Fax Sent 19149395801 2:14 3 OK N/A DD AUG 18 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Technical Report prepared for: MH Tank Co. P.O. Box 428 (50 Spanktown Road) Warwick NY, 10990 Attention: Mike Hoensch Report Date: 07/03/2017 Client Project ID: Carpinello/Petro York Project (SDG) No.: 17FO857 PC CT Cen Nu PH-0723 New Jersey Cen.Nu CT005 and 14YO37 A New}ork Cm.Inns.10834 and 12058 PA Cm.No 68.04440 7e 120 RESEARCH DRIVE STRATFORD,CT 06615 132-02 891h AVENUE RICHMOND HILL,NY 11418 www.YORKLAB.corn (203)329-1371 FAX(203)357-0166 Ch"Services@yorklab com Page 1 of 13 Report Date: 07/03/2017 Client Project ID: Carpinello/Petro York Project(SDG)No.: 17FO857 MH Tank Co. P.O. Box 428 (50 Spanktown Road) Wanvick NY, 10990 Attention: Mike Hoensch Purpose and Results This report contains the analytical data for the sample(s) identified on the attached chain-of-custody received in our laboratory on June 22,2017 and listed below. The project was identified as your project: Carpinello/Petro. The analyses were conducted utilizing appropriate EPA. Standard Methods, and ASTM methods as detailed in the data summary tables. All samples were received in proper condition meeting the customary acceptance requirements for environmental samples except those indicated under the Notes section of this report. All analyses met the method and laboratory standard operating procedure requirements except as indicated by any data flags the meaning of which are explained in the attachment to this report,and case narrative if applicable. The results of the analyses. which are all reported on dry Height basis (soils) unless otherwise noted. are detailed in the following pages. Please contact Client Services at 203.325.1371 with any questions regarding this report. York Sample ID Client Sample 1 U Matrix Date Collected Date Received 17F0857-01 I Soil 06/20/2017 06/22/2017 General Notes for York Project(SDG)No.: 17FO857 I. The RLs and MDLs (Reporting Limit and Method Detection Limit respectively) reported are adjusted for any dilution necessary due to the levels of target and/or non-target analyzes and matrix interference. The RL(REPORTING LIMIT) is based upon the lowest standard utilized for the calibration where applicable. 2. Samples are retained for a period of thirty days after submittal of report,unless other arrangements are made. 3. York's liability for the above data is limited to the dollar value paid to York for the referenced project. 4. This report shall not be reproduced without the written approval of York Analytical Laboratories.Inc. 5. All samples were received in proper condition for analysis with proper documentation,unless otherwise noted. 6. All analyses conducted met method or Laboratory SOP requirements.See the Qualifiers and/or Narrative sections for further information. 7. It is noted that no analyses reported herein were subcontracted to another laboratory,unless noted in the report. 8. This report reflects results that relate only to the samples submitted on the attached chain-of-custody form(s)received by York. 9. Analyses conducted at York Analytical Laboratories, Inc. Stratford. CT are indicated by NY Cert. No. 10854. those conducted at York Analytical Laboratories.Inc..Richmond Hill.NY are indicated by NY Cert.No. 12058. Approved By: 1�4 Date: 07/03/2017 Benjamin Gulizia Laboratory Director Page 2 of 13 1 Sample Information Client Sample ID: 1 Vork Sample ID: 17FO857-01 York Project(SDG I NLL C'licnt Project I Matrix C'olleeuon Date,,Time Date Rcco%cd 17FO857 Carpinello/Petro Soll June 20.2017 3:00 pm W22 201' %'olatile Organics.8260 List Lop-in Notes: Sample Notes:VOA-CONT �,ni is Ih,p.u.J h•.\I;rt,a1 I-I'1<u:<q Kq.md, DaPNl7are Data/rttle CAS No. Parameter Rash Flag Units LODI'swi. I()Q Dilution Reference Method PrepaM Ar1ya111 Analyst 630.20.6 I,I,1.2-Tetrachlonx:thanc ND upkc dry 29 57 1 IP\eNOc 0628201707.30 O&MO1716.2.1 SS LMn1CU11a1. (TI)UH.NELAC-NY10854,NIDEP.PAI)EP 71-551 1.1.1-Tnch loroedwrit ND us'ke dr) 29 5.7 I EPA 9260C ONM201107:30 06.2a201716:23 SS cm.rfw- (TDOH.NE1AC-NV10854,NJDEP.PADFP 79.34.3 I,1.2.2-Tetrachlonietham ND ue''ke dr) 2.9 3.7 1 EPA 8260C ONZLM1707:30 0628R01716.23 SS C'eNfKuwm (7WHAELAC-NY 10854.WDEP.PADEP 7f.13-1 1.1.2-Tnchloro-I2,2-tri0uoroethane ND u61,g dry 'V 5.7 1 EPA 92W 0628.20170730 0629W]71623 SS (Freon 113) ccmr atronr C7D01f,NFLAC-NY 10854.NMEP 70.00.5 1.1.2-Tnchloroedtane ND ustg do 29 57 I EPA 92W 0629201,07,30 0621V20171623 SS (eruficst- CTD01lNFIAC-VY1005i.NIDEPPADEP 75.34.3 I.1-DIChIgpCUlanc ND ug kg dry 29 57 1 EPA 8260C 06262017 07 30 06 2812011 16 21 SS CMifKntom CTDOH.NELAC-NY l0x54.NJDEP.PADEP 75.35.4 1.1-Dicblorocthylenc ND ug►g dry 29 57 1 EPA 8260C 06rS92017 07 30 06 21201-16 23 SS Ceruficatt E1WHNELAC-NY10N54NJDEP.PADE► 563.58.E I.I-Dichloropropylene ND upl g do '_9 57 1 EPA g260C 0626201-07-.30 061x•2017 163i Ss cMnficataau. NF1-AC-NYI0854•NMEPPADEP 87.61-6 1.2.3-Tnchlurubcnzcnc ND ug kg do '4 5.7 1 EPA A2hW 0629,2011 u7 30 a628201,16•3 SS Cmtftcnwta NELAC-NY101154.N MAPAIMP 9r.lx� 1 2.3-Tnchluropropunc ND ug.kg Jr) 29 5.7 1 EPA 82W OWN 201'0730 06 M017 I6.23 SS CatafKanonr NELAC-NY 10854NA)EP I ZO.82-I 1.14-Tnchh3mbewenc ND ug kg do 2.9 57 1 EPA 826W 062&2011 W7:30 ot-I MP 16.23 SS (er6(tuttunr NELAC-NY10854NIDEPPADEP 95.63-6 1.2.4_Trimuthylbcn2rne ND ufkgdr) 29 57 1 FPA 9160C 66 28201-0'90 06211,2111?16-23 SS C1 a.rc e- CTD0H.NF2AC-NY10854.NRWPPADEP 964I14 1.2-Dibrom(r3-chlun,prupane ND ugdg dr) 24 57 1 EPA 926X 06282or 07:30 06:2"1'16-1 SS CMiftun . CTDUH,NELAC-NY 10854.N)DEPPADFP 106434 1.2-Dibromocthanc ND ug kg jr) '9 5 7 1 EPA 9260C a62x 201707,30 06(2MI7 1623 SS Crntftcatou: CTIX)HNELAC-NY I0a34,NJDFP.PA1" 95.50.1 1.2-DichIorubenzene ND u x )k•Jn 2 v (] 1 EPA 826OC' 062x M170'30 061Sa,7J01'la 23 SS CMtftcat- CTDOH.NELAC-NYIOe54•WDEP.PADEP 1074)r,2 1.2-Dichlorocthane ND ug kg Jry 2 0 5 7 1 EPA 826K 062LM1707 30 062VM171623 SS Certrrtctltotu (-MH.NELAC-NY10854.NMEP.PADEP 7A-97-5 I.-''-Dichloropropane VD ug kg Jn 2 v 57 I EPA 92MK' O6'28,201707 30 062W2017 16.23 SS Cemf-b- CTDOII.NELAC-NYIONS4.VJDEP.PADEP I0"7.N 1.3.5-Tnnlcthy[benzene VD ug kg do 2.9 5.7 1 EPA 8260(' 06'26201707:30 06210201716:23 SS C'Mrfica CTD0HNELAC-NYI0a54.NR*P.PADFP 541-13-1 L1-Dnchlorobevenc ND ug kg do 24 37 1 EPA 92W ON2s201707..10 062WO1716.23 SS CMtrKatwm f1DOH,NELAC-%Y10854,WDEP.PADEP 1.3-DichI�,,pr0panc ND ugkg Jn 29 57 I EPA 8260(' 0610 201707.30 062xQ01716.23 SS ccntrtul- A'ELAC-NY10854\JDEP,P.ADFP 120 RESEARCH DRIVE STRATFORD CT 06615 ■ 132-02 891h AVENUE RICHMOND HILL NY 11418 www YORKLAB.coni 1203)325-1371 FAX(203)357-0166 CtentServtcec- Page 3 of 13 I Sample Information Clent Sample iD: 1 fork Sample ID: 17FO857-01 York Project 15113(i1 No. Client Pro to ID Maim Collcctlun Daterl lmc Date ReceiYed 17F0857 Carpinello/Petru Soil June'_II,2017 3 oo pm 0622 2017 Volatile Oreanics.82"Ust Loa-in Notes: Sample Notes:VOA-CONT Sample Prepwd h)%i d A:EPA 5035A A°p nrf 4 Daterrime Date/Tinie CAS No. Psursaw er Result Flag Gaits LODAIDL Ltlp Dilution Reference Method Prepared ARM" Analyst 106.46.7 1.4-DichlorohCn7CnC ND us-►s do 2.9 5 7 1 EPA 82W 0626201707:30 06 282111-16 2; SS Cmif,-- (TWH.N'ELAC-NYln$IS4NIDEP.PADEP 123-91-1 1.4-Dioxanc ND uglkg dry 57 11n 1 EPA 8260C 06211401707 30 n6.28201-16 23 SS cmir ou- NELAC-NY 10154.N1DEPPADEP 394-20.7 2.2-Dichloropropanc ND ug►g&r, 29 5.7 1 EPA 826017 0b2a 201107.30 0629201716.23 SS Cmr-tioric NF:LAC-NY 1011544JDE.P 7A-41.3 2-Butan.w ND ug:kg do 29 5.7 1 EPA A26tIC 06,28,201707.36 0628:01?16:?t $S Certl1ica6ons (-=H,NFLAC-NY 108S4,NJDE.P.PADEP t 95.49_9 _'-Chlurotoluene ND ug-kg dr) 29 5.7 1 EPA 82W 00,211.2011 V,30 0628r201`1623 SS tt+I Cer9f8:4dons. CTDDILNELAC-hYlug54,NJDEPPAI" 10643.4 4-Chlurotoluent ND ug#s do 29 57 1 EPA 9261K 062t+201707:10 0628.101716'2) SS ccmfica-s- CTIX)H.NELAC-hY 10[34.N)DEP.PADEP 67-64.1 Acclone ND 9gk[dry 31 11 1 EPA 11260C 1*2912017 07:30 0621401-16 23 SS Cmificmona CTDOH,NELAC•NYIojii4.IJDEP.PADEP Bcnme ND upkg dr) 29 57 1 EPA 9260C 6621120170741 0628.201'1621 SS Crrulicnl0m. (1WH.NELAC.NY101154,NMEPPADEP I Oa•10.•I Brnmoheniene ND ug kg dry 29 57 1 EPA 8260C 0629201'07.30 01529201716.23 SS CM.Wm- NELAC-NY I(W54UI)EP.P.ADFP 74.47-5 Brotnochlunimclhanc ND ug#g dry 29 5.7 1 EPA 926W 0b29401707.30 962A401716:2.1 SS (cmf alkals. NELAC-NYI0154.N11)EP.PIDEP 75-214 Bronnudichloromethane ND u['kg dry 2.9 57 1 EPA 82W )162a2017 W,30 062L20171623 SS cmuketa C1WH.NELAC-NYI0A54NJDEPPADEP 75-25-2 Bromolorm ND ug kg dr) 29 57 1 EPA 8260C 06 23.2017 07,30 Of,=20111623 SS Ccn.r f- CTDpHNELAC-NYIOa54.NJDEPPADEP 14.83-9 Bromoniciliano ND us I v dr) 29 5 7 1 EPA 8260C 06.24201'0'.30 06 282017 16 2) SS Ccnlncau.wts CTDOHNELAC•NY IiMU-NIDEP.PADEP 56-21-5 Carbon ictrachlondc ND WFt[dry 29 57 I EPA 8160(' 0623,20I707:30 062A2017 I6.23 SS Cmdcalwlo C1D0H,NELAC-Nk'I01154NJDEPPADE► 109.90.7 Chlurobenitne VD urks dr) 29 5.7 1 EPA 8.'W' 062L201707.30 06 2SI2017 16.13 SS Cvn,rwa,-. (11()(NkLAC-NY 10854AH)PP.PADLP 75.1w1-3 (hlunmthanC ND ug kg Jn 2.0 17 I EPA 82W 06,11.201707 30 IK28:01716.23 SS Cw,rk - (-TDOH,NFLA('•NY10854,NJM.p.PADEP 67-W.4 Chlorofuml ND ug I Jr. 29 5 7 1 EPA A260C 0628,2011 u7 30 0623/2017 16'23 SS l'ernfieaaons: CTDOIINELAC•NYI0954.N)DEPPADEP 74.97.3 Chloromethane VD ug kg dry 14 57 1 EPA A260C 06A201707.30 0628/2017 16:23 SS 470106csb- CTD0ILNELAC-NYIO[S4.NJDEPPADEP 156.59.2 cis-1.2-Dichloroethylcne ND ugkgdn 29 57 1 EPA 8260C 0629,201707:30 0628,20111623 SS cmliicsi- (TWH.NELAC-NY I 0954.N1DEPPADEP 10061-01.5 cis-1.3-Dichioropropylene ND ug kw dr> 2 v 5 7 I EPA S260C 062&201107,30 n62"I0 I6.2) SS Cm.ri-oft': CTnoH.NELAC-NY 101554I.WDEPPADEP 12448.1 Dibromuchloromethant ND ug kg do 2" c 7 1 EPA 9260C 06M29201707 30 0621v201'16.23 SS ('mlfa inirs. NELAC-NY 10854N1(H:P.P.ADFP 120 RESEARCH DRIVE STRATFORD CT 06615 8 132-02 891h AVENUE RICHMOND HILL.NY 11416 www.YORKLAS corn (203)325-1371 FAX(203)357-0166 ChentSwvlces Page 4 of 13 1 Sample Information Client SamDle ] York SamDle 1D: 17F0857-01 York Proicet ISM No Client Proiect ID Matrix Collection DateTlmc Date Receivrd 17FO857 Carpmello7Peiro Soil June 20.2017 3 00 pm 06/22 20 1 7 Volatile ornalcL 8260 List Lop-in Notes: Sample Notes:VOA-CONT Sample flepeled by%1011011:EPA 5035A Req,nnl�„ Date/l'ime Dattr/rlme CAS No. Por•aseter Result Fins Units Lc,D/31DL LOQ Dilution Reference tiletbod Prepared Analyzed Analyst '4.95.3 Dibromo(nedlane ND ug kg Jr} ]v <7 1 EPA 1126(K IW2t2017 0790 06.212017 16.23 SS C'enifiemn- NELAC-NYIO854.41DrPPADFP 75.71.8 Dichlorodifluoromolhaac ND ug kg dry !.9 ill 1 EPn8260C 116292111-0730 062620171623 SS Cenifka-s NELAC-NY10844\mEPPADEP 10041.4 Ethyl Benzene ND ug kg do 2.9 5 7 l FPA 826W 0628-201701 40 0621V201•I6.!3 SS Caufiutwm CT)ON«IEIAC-\YIO@34,NJDEPPADEr 81fi11.3 {IfCAChhei)hUlalhelte ND ug kg do ''I }7 I FPA 9260C' IM2t'MI71/7:30 06.2a:01;16.23 SS ('rnlr",Mr VELAc-NY 10a54•N1t1EP•PADFP 99-92-8 Isopropslhctlzene ND ug kg Jn '_9 t_7 1 EPA 8!60C O67&201707.30 0&2L201-16:-13 SS C n.r.auom: CTDOII•NELAC-4Y10854.NJDEPPADEP Ibu1►f-4 Methyl 1m-hutyl ether Ih1TBE1 ND ugig Jn !v 17 I FPA 92fim 06211,10170730 u621201.1623 $S Crnlfic4nu C-rD011.NELAC-NYIM54.Nimp..PADep 75.09.2 Methvlene chlondc ND ug kg Jr) 57 11 I EPA 8260C 062t211170•.141 0628201-16!3 SS Caufianaq CTDOH•NELAC-NYI0a54.NJDEP.PADEP 91.20-3 Naphlhalenc ND ug kg do :v I I 1 EPA 8260C 06M2011 07 30 062a,2017 16 23 $S 114-51-x CrnirkAu , NEI-AC-NY 10034.N1DEP•PADEP n-Buty Ibenzene ug kg Jr) 29 5 7 t FPA 8260C 06.21b201707.30 11621401-16.J $$ Cauficatwm_ CIDOHAELAC•AY 10N54.NJDI:PPADIl 103-n5-1 n-Prop.ihctvcnc ND ug tg do 2,) �7 I FPA 8260C 06 28'20I.07:30 06-'a2017 16 23 SS Catificawm. (TI)OH,NELAC-NY 10a54,N11*..P.PADEP 95-476 1 Xyletle ND ugkg Jn 2.9 5 7 1 Ern 8260C o629,2017 073o Ob 2I.2017 te23 ss ('aniacatlotu: CTIICJILNEtAC-SYIO8s4.PADEP 179mH-23.1 p-&in-X3lenes VD ug kg Jn 5 7 11 I EPA N260C' 06:t2017 07:30 062 81201 7 16:23 $S C'anfieawna: CTDOII.NELAC•NY10as4.PADEP 99 s7. p-60propyholucne NU ug kit Jn 2V 57 I EPA 8260C 0b26201707)(1 0621020171623 SS /tNtictlxnr I35-98-8 sCC-B0lyiben(COe CTDOM,NELAC-NYIOI54,NMEP.PADEP NU ug kg,1�-, 29 t 7 I EPA 8260C 0629201,07:30 06211,201116.2.1 S5 C'ert r"I.Nu (TTX)H,NEIAC.NYIO$54.NJDEP.PADEP IOU-12-( Styrene ND ug lg,1n •4 57 1 FPA 8260C' 06•21701707.30 06Q826016.23 SS Cenifkm,*,u. (TD(JH.NFLAC-SYIO1542NJDI:P.PADfP vs-n6.6 0.•n•Hunllwnzrue ND IV kg Jn '9 (.7 1 EPA 9260(' W 11:2017 07:30 06,'•VZ017 16:23 S$ (:er6ficanau; CTIIOH.NFLAC-NV 1085i.N11JEP•PAI)F.P 121-i x-a Telrachktn�ell'ricne ND uE kg do `9 5 7 I EPA 9260C (1628 2017 07:30 06282017 16 23 SS C'atilk4nau. (TDOH.NEIAC'-SY I0854.N)DEP.PADEP tOx-RN-3 Toluene ND ugkg Jn 2� 5 7 I FPA 92M1C 062t 2017 11730 tin 2N20I7 16,23 SS c'entfiew-, CT'IX1I1,4ELAC-SY 10I54.NIDERPADEP IS6e-0 trans-l.2-DicMarnethykroe ND u t do 29 E 8 5 7 I EPA 8260C 0628'201707:10 06282017 t6:23 $$ l'ertilka H. uum CTDONELAC-SY 1o8s4,NJDEP.PADEP 1006!-0=�, trans-I.3-01chloropropy lone ND ug kg do !9 17 I EPA 8260C IM21,201707:30 062t1A1?I6:23 $$ Cetufieann4r. (TDOH,NELA(�Y10854.NJf*P.PADEP 79.0i 1. TnchlonKthyiene ND ugkg Jn !4 17 I EPA 926K 06 N. 2 2017 07:30 66 n2017 16:21 $$ Crnlfiatums. 4L'11)044.NELAC-SY I01454,NJIMPTADFP 120 RESEARCH DRIVE STRATFORD CT 06615 ■ i32-0289thAVENUE RICHMOND HILL,NV11416 lvww YORKLAB corn (203)325-1371 FAX(203)357-0166 ChentServlces Page 5 of 13 i 1 RK Sample Information SIIeDt Sample ID: 1 York Sample ID: 17FO857-01 York Protect ISDCi1 No L hem 11noleci ID Matrix Collection Date/Time Date Received 17FOX57 ('arpmello/Petro Soil June 20.2017 3:00 pm 06/22,2017 Volatile Organics'8260 Lbj Log-in Notes: Sample Notes:VOA-CONT Sample Prepared by Mlhn ed:ETA 5035A CAS No. Daternme Date/Time Parameter Rnult Flag Units LDD 5IDI. L1q Dilution Reference Method Prepared Analyzed Analyst `-64-4 Inchloro0uoromethanc NU utlgJn _� EPA 8260C 0621,201'0?30 0628201'16 23 SS c rnl6cu,nro CTDOH.NELAC•NY 1084.NIDEP.PADEP 108J)5.4 Vinyl acetate NU ng►t dry 2.1) a, EPA 82(Ac' 06'211,20170710 06211,20171621 SS Cmfi—lions NELAC-NY10854.41r)EP.PADFP 75.01-I Vinyl Chloride ND ug kt dry 29 17 I FPA 8260C' 06211,201707;30 062L201716:21 SS Ce"Wicats6m: CTDONAFLAC-NY 10a54.N)DEP,PADEP 1 t3n-2u-7 Xylerles.Taal NU uc le Jn x,. i+ I FPA S26W 0629 2017 07.30 067"1'16.2.1 SS CcmrkaLwu. CTDOH,NF•LAC-NY 1004,N.IDE:P Surrogate Recoveries Result AeeePtaece Range 17060-07.0 S0T79ate.I.2-Dlchlometbann44 IOI% ---us 2017.26-5 Surrogute roluene-sl8 IOU: RS•I:B 4tA-fYI-J S—Rare p-Bmsnolhwmhenrene 106°,. 76-/JB Semi-Volatiles,8270 Tareet List Lot-in Notes: Sample Notes_:_ Sample Pr Ixv'J b5 Method:EPA 1550C CAS No. Parstaeter Rewned to Datdrime Date/T Result Flag UoMs LDUMDI LOQ Dilution Reference Method Prepared Analyzed Analyst 12n-e_-1 L2.4-Tn.hlontbcna•nc ND ug kg do 477 451 EPA 82701) 06 27,201'05 46 0701201'22 2: sR Ccrufik tms (rDOII,NELAC•NYIMS4.N2DEPPADEP °`'`O-1 I?-Dlchlurohcnzcnc NU kg Jn J?; 95i EPAS270D 04 27201 7 05:46 07AIrZop ZZ:22 SR ('miricasxmr NELAC-NYIU84PADEP 41=3-I 1.3.Dichlombcnzem ND uglg dry 4'7 951 2 EPA 8270D 0627-201'05:16 07,01201722.22 SR CrnlOcauom: NFLAC-NY'10654.PADE►Inn-t6.7 1.1-Dichlumtxlvenc ND uglg Jn 4^7 05 I T:PA 9270D 0627 201,05.46 07.OM17 22:22 SR Cerblicv—, NFLA('-N)'IU84.PADEP 95-95-I _J,5-Tnchlur,phelwl ND us kg d.) 47 7 95 1 2 EPA 9270D 116272017 05:40 07N12017 22.22 SR .A.A-Tnchloruphrnol ('aurtca,ons. (-TDOH.NFLAC-NY 1084.WDEP•PADEP 8R-ta:2 V D u8 kg dry 4-7 951 _ EPA 92701) 0627 m1'.05 46 07,0112017 22:21 SR 1211.81.2 2,0.Dichloro hcnol Centfc'mm I-MII.NELAC-NYIM4-NJDEPPADk? P ND Wit tin 4'7 951 - EPA 827,01) t1627.201�05" 07,OL201722-22 SR Caeic i—s CTIX4I.14ELAC-NYIM54•NIDEP,PADEP IOSfi7.9 2,0.Dimethylphcn0l ND ug�kt dry 47.7 951 2 EPA 8270D 0627260 05:46 07012017 22:22 SR Ccrtirs.t— CTDOH.NELAC-NY10834.N3DFP.PADEP 51.28.5 2,0.Dinitrophcnul ty D us kg do 951 1911 - EPA 8270D 06272111'05:46 0741,201722:22 SR Crn,riunom. CTDOH.NELAC.NYIm4N)nEPPADEP 121-W2 _'.J-DiNlmkalutne ND ut 1g do 4'7 95I EPA 8270D 06'27.201'05:46 0701201'22:22 SR CemtieaUnn,. ITDOIINELAC-NY IOBS4,NIUF.P.PAUEP 606.20.I ''.f.-DmllnquluCne ND ug,kg Jn 1'7 95 I EP.18270D 0627m17 05:46 07.01 n-01'L':22 SR Caurtcatwns. (TDOH.NELAC•NYIOa4.N31*.P,PADEP 91.SN-� ?-('hloron4ph1hulcne ND uB kg Jr. 4'' vs 1 _ FPA 827013 06 27'201'U5:4e 07%p12017 22:22 SR C'emrtca6ans CTDININELAC.%'Y 10854NMEppADEP 120 RESEARCH DRIVE STRATFORD CT 06615 ■ 132-02 891h AVENUE RtCHMOND HILL,NY 11478 wv.w YORKLAB.com (2031325•1371 FAX 1203)357-0166 ChentServtces Page 6 of 13 I Sample Information Client Sample 1D: l fork Sample ID: 17FO857-01 York Project iSDGI No Uml Proie(a ID Matrix Collection Date7ime Datc Recen'ed 17FO857 Carpinello/Peiro Sod June 20.3017 3:00 pm 0622 2U17 Semi-Volatiles.8270 Target List Loe-in Notes: Sample Notes: ,ample Prepared h)Method-EPA t55Ot' Date/Time Date/Time CAS No. Parameter Resale Flat Units ((1D.'NDL Lt)q Dilution Reference Method Prepared An Analyst Anal t hem,l 95-57.8 '-Chh,ru P ND uE�kg Jry J77 01 _ EPA 6270D 0627401-05:46 0701R01722:22 SR Ccnrkc . C7DOHNElAC•NY IWs4mDEPPADEP 91•57d '-Math,lnaphthalenc NJ) us,kg dry 47.7 951 2 EPA 8270D 0647201^05,46 07,OJ 12OJ7 22 22 SR Caufaata CTDOHNELAC•NY10854.NJDEPPADEP 95.48.7 '-Mrlhylphcnul VU ug kg Jn 477 v51 _ EPA 827013 06,27201105.46 07:06201722:22 SR ferulte+nons- (-TUO NELAC•NY 101154,WDFPPADFP 88.74L1 2-Nnruamhnr NU uK kK Jn 941 ;`X1 - EPA 8270D 06'27,2017 05:4e 07AIrt01.22:22 SR C'cnrfrcarwu C1)OH,NELAC•NY10854.N1DF"P.PADEP 8a•75-3 Z-Ntlmphcuul NU ug kg Jn J7? 951 - EPA 8270D 0627,201'05:46 0701201122:22 SR Cem0c4nom: CTOr111NELAC•NY10834,N)W.PADEP 65794.96.9 3-&4-Mnhylphcnols ND uK kg Jn 477 v5.1 - EPA 8270D (16 27 2017 05:46 07 IN 2017 22 22 SR CrnrOca:ons CTDOI INELAC-NY IOR34N1DEPPADEP 91-9.1•I 3t-Dichlorohc0ztdine ND ug kg dry 477 951 1 EPA2270D 06,27a0170346 07101/201722:22 SR C-emfi,m- NELAC-NY10054.WpEPPADEp 9-09-2 3-Nitruanihnc ND ugkadry 93I 190 _ EPA 8270D 0627201703:46 0701201722:22 SR Ccrtlncmt . EMWNELAC-NY 10854,N)MPADEP 514-52-I {•bDiaitr0-2-nutM•Iphrrn,l ND u t B'g drY v5.1 190 2 EPA 9270D 0627101'05:46 0701 W17 V-22 SR I01.55-5 4-Brorrnrpheml pha•nyl ethe (' r erufrat- (-1`1XKNhLAC-NY I0854,N111FPPA1JhP Np upkg dry 47.7 951 2 EPA 8270D 0627201705:46 07.01:01722:22 SR C'cruftc -, C")OH,NELAC•NY10R34,N11Jf P.PADEP 19.30.7 1-ChlOro-i_nuthylphrnul ND u t 8' g dry 477 95.1 2 EPA 92701) 0627'201705:46 07,01.2017 22:22 SR Ccrufi awor C7DOII.NFIAC--NYIOR54NWEpPADEp 10647.8 .6('h I u r c,a n i li n e ND ugtg dry 477 9$.) _ EPA 8270D 0627:2017 05:46 07/01/2017 22-22 SR Can,frcamm (TDOI INFLAC-Ny 10051.N)DEP.PADEP 7�5-72-1 J-('hi0rr,phrnyl phenyl ether NU u g1q dry J7 7 951 2 EPA 9270D 0627/20170546 07 012017 22.22 SR Ccmficamnr CTDON 4ELAC•NYIORI14MDEPPADEP 100-01-6 4-Nnroandinc ND ug kg dry 93.1 190 2 EPA 8270D 0627.201^OS:46 0701201722:22 SR frmliummc. (TDOHNELAGITY 10834,N1DERPADEP I00-t1t-7 4-]nrophennl N D u¢\g Jry 951 19O EPA 8270D 0627,2017 OS:46 07.0120172212 SR 83-32-9 A e.aphthenc C'enrfiuumu CTDOHNL AC•NY 101154NJDEP.PADEP ND u9AS dry 477 951 2 EPA R270D 0627201705:46 07,01Q01722:22 SR ('enifinuuo.. CrpOH,NFLAC-NY 10834.N1DF:P•PADFP 20ft'9f.M Acenaphthy lerve ND ur kg dry 47.7 95.1 2 EPA R270p 042730170546 0701401122.22 SR C•rmficat- (TDOH.NELAC--NY 10854.NIDEP.PADEP Aniline ND uK kg Jp 194) -1A 1 2 h:PA 8270D 06'27 201105:46 07 01,201'22 22 SR Anthraar1c CCertifications. NELAC-NY 10R54.N1DEP.pADE.p 12n-1•_-' NU ughKdn J^7 951 _ EP:k827pp -7201705-46 0701.201-2222 SR c:r.trftcan.n. CTDOHNELAC-NYHrt54N1DEP.PADEp 56.55-1 Hcvulalanthraccnc ND us\g do 47' 95 I _ EPA 8270D 0627201703.46 07,01 201'22.22 SR Camficaxmr (-IU)H.NFLAC-NY I OID4.NIDEP,pApEP 50.t2-r Hevnralpyrrnr ND u9kgdn 477 95I _ FPAA^_YID 0627,201705:46 07.31120172122 SR Crnrlruunru: C7130KNELAC-NY 10854•NIDEPPAIM:P 126 RESEARCH DRIVE STRATFORD CT t16615 0 132-02 89th AVENUE RtCHMONO HILL NY 11418 www YORKLAB com (2031 325-1371 FAX 4203)357-0166 ChentServlces Page 7 of 13 I Sample Information CIieDI Sample W: ] York Sample ID: 17F0857.81 York Project ISDGI No Client 1'mw ID Main x Collection Date/Time Date Received 17FO857 Carpinello/Pelro Soil June 20,2017 3:00 pm 06/22/2017 Semi-Volatiles,8270 Target List Lou-in Notes: Sample Notes: sample Prepared by method:EPA)S3iR' R,p,med t9 Date Time Date(Frle CAS No. ParamNe► Result Flag Units LODAIDL LOQ Dilution Refercncc 11tihud Prepared Alaalysed Analyst 205.99.2 Bcnadblllunra)dhcric ND ulpkgdrr 477 951 2 EP.4 112,7411) tt627,201703:46 07'011201722:22 SR CemfKa611nr. CTDON.NELAC•NY Joa54.NJDEPPADEP I91-24.2 Bcn/'49.11.1 1pvq tent ND up kit do 477 93 1 _ EPA 9270D 0627,2017 05:46 0701W72.122 SR Cem(Katwm+ CTDOH.NELAC-NY 101154N1DEP.PADEP 207-0s.0 BCrvolkllluoranlhcnc ND up 1p do 41, 441 _ EPAx27013 06 27 201"03 46 07012011L22 SR CerlrfKaltnru C1UM.NPyAC•NYI0a54.KJDEPFADFP 100.51-n Brnzyl aILL*oi ND uppkp Jn 477 441 _ EPA 02701) 0627:201705:46 07,011201722:22 SR CcmrKA-. NFLAC-NY 10654,N1UFP.P.koEP N5b11•? Beryl butyl phthalat0 4D up kg do 47.7 95I _ EPA x2?OU Oe27 201-03 4e 07ro11201722:22 SR ('emfKatronc CTDOILNELAC•NY10$54.NJUEP.PADEP III-91•I Bix(2-chluroethoxy lmeth;0ie ND ug is Jry 477 451 EPA x270D 0627201-0446 07:21R01722:22 SR ('erbrrrt,-: (TOMH,NELAC-NY10854.NJDEP.PADFP 111-4" Bia12-chlorocthyl lciher ND qt tp dr) 47 7 951 2 EPA 82701) 0&17,2017 05 46 07t0MI722:22 SR Cemf"fi- CTDON.NELAC-NYIO$54.NJDEP,PADEP 109-eo-I Bis12-chloroisopropyl lcthcr 4D u 8 kV do 4'7 y3 I 2 FPA 8270D 06 Z720I1 05:46 07�01.2017 L.22 SR iem0catiuer L-M0HNE1.A('-NY IOs34,N1DE►.PADEP I n•NI-7 Bis/2-ethylhexyllphthalaic ND up kg,tn 47 7 951 _ r•PAx.,70D 0627,20170546 9701rz0I72222 SR 21g Cemf.ml (TDOH.NF.LAC'•NY IOs54.NiDhP.PADFP -0I-v ('h acne r ND up kv dry 47.7 951 _ EPA 8270D OM7,20170(:46 07,91,201•2,:22 SR C'emrK4t- (TDOH,NELA('•kY1ox54,NJDEP.PAIIF:► i i.7t!-i D1t+enrtN a.h lanlhrecene VD u k do 4'7 s 8 45 t _ EPAN270D 06.27201'05A6 07,Ot401722:22 SR C'emfKaums C2DOII,NELAC-NYIOs54,NR)EPPADEP 112.64.9 Dit+enzotwan ND ug•Yg do 47 7 931 EPA 8270D 06 27201105 46 07,012017 22:22 SR CefnfKsttonr (-TUGH.NELAC-NY 101-4.N1DEP PADF.P U-6(.= Dicthyl phthalate ND upkp dr) 477 95 I EPA 8270D 06272017 0 46 07012017 22:22 SR C'erbfK.I.- CTDOH,IELAC-NY Iog54NJDEP•PADEP 131-11.3 Dimcth)l phthalate ND up k8 dr) 47 7 951 2 EP.4827(N) i1627201703:46 07.01201122.22 SR CmficuKnls: (TDOH.NELAC-NYIOs34N1DEP•PADEP x4.7s Di -butyl phthalate ND u`kp dry 47 7 951 2 EPA R270D 0627 201 1 05:46 0701201'L:L SR CeaifKm--. (-rDOH,Ni:LAC-NYIOx54,NJIX:P•PADI:p 117.94-0 Di-n-ocrvi phthalate ND up kg dr) 47.7 951 _ F.PA x270p 0621,201703a6 U701201722.22 SR Cer"wmi- (T)0H.NF..LAC•NY I(a34,N1DEP.PADE► 2(M�-1.0 hluuramhcne VD ug.4g dry 477 951 2 EPA 9270D 0627201,05:46 07,012017L:22 SR x6-?t.7 Fluurene C'erufia DO mns I TI INELACNY IW34N1DEPPADEP ND ug/ltp dry 47.7 451 - EPA N270D 0627201'Oe:46 07012017 22:22 SR (emfKnrons- NELAC-NY 10854.-,LWP.PADPP IIN•'4-I Hesachlorohen[enc NU ughp dry 477 951 2 EPA 8270D 0627201'(3.46 0701.,201?22:22 SR Crb efK:4lwn.. CfDOH.NCLCC•NYIOs34.N1DEPPADEP x7.o8-) Ilcsachlurubwmhcnc ND ug kg dr) 47 7 951 z EPA 8270D 0627201,05" 0701201.22.22 SR Cemt"l,-.: (TDONNELAC•NY10s54•WDEP.PADEP 77.474 HesachlunxyAu{+eriirdlrne ND up kg Jn 47 7 9e I _ EPA g210D 0627201'05." 0701201'22.22 SR (-enlf-immu. C-rDOHNFLAC%Y10954.NJDEPPADI P 120 RESEARCH DRIVE STRATFORD CT 06615 132-02 89th AVENUE RICHMOND HILL NY 11418 www YORKLAB corn (203)325-1371 FAX 12031 357-0166 ClrentSernces Page 8 of 13 1 Sample Information CReet Sample In; I V'ork Samok ID: 17FOB57-01 York Proiect ISM Nn Cllenl emm ID Matrix Collection Date/Time Date Received 17FOR57 CarpinellolPetro Soil lone 20.2017 3:00 pm 06122 2017 Semi-Volotiles,8270 Target List Loe-in Notes: Sample Notes: SamPle I'mPmed by Mohod I PA AsAlk' ('AS No. Repini .' Dare?ime Detdrhw Parameter Rnsk Fla` Ualq LODAIDL LOQ DOutlon Reference Method Prepared Aaalymd Analyst Hexachlowiltanc ND ug kg do 477 951 2 EPA 62701) 0627Q017 05:46 0741:2017 22:22 SR C'emfrc.h- C'TDOH.NELAC-NY I0854.Nit)EPPADEP 19;.19_: IndeW I'.3-cdiryrenc ND ug kg dry 47 7 45 1 EPA N"OD Or.2720I"05:46 07ro1201"22.22 SR Cenif nano (TIX)H.NEIAC•NYI0tl54.N1DEP.PADCP 79-59-1 kophuronc ND u k 8' 8dry 477 951 FPA 9270p 0627.2017 o5*a6 07.01201722.22 SR Cemfiuraats: CTDOII.NELAC-NY10954.NJDh.PPADEP 91-20.3 Naphthalene ND ughg dry 47.7 951 2 FPA E270p 061.7,20I7 05.46 0741201722:22 SR C cnf,"r CTDON.NELAC•NYID854.N11N:PPADEP 98.95.3 Nitrobennne ND ughg dry 47.7 951 _ EPA 11.270D 0627.2017 03:46 07.01 r201'2242 SR Ca4fica-. CRNHI.NELAC•NYI(nt34.NJDEP.PADEP 62-75.9 N-Nilroxodlmelhylammc ND ugkgdry 477 95.1 2 EPAX270D 0617 2017 05.46 07,01t201722:22 SR (etnf-h- CTD0ILNELAC-NYI0354.NJDEPPADEP 621.64-7 N-nnn„o-di-n-propylaminc ND ugAg dry 477 951 2 EPA 8270D 0627,201705:46 07,0IR01721:22 SR Cemf.n.ns CTDOH.NELAC-NYIOg54.N1DEPPADEP W.10-6 N-Nnnnodlphenylaminc ND ugAS dry 471 951 . EPA 82700 0627201705 46 0701,20112212 SR Certirtea-v C1T)OH.NELAC-141Y 10854.N)DEPPADEP 97-96-5 Pen tach lord head P ND ngkg dry 477 93.1 2 FPA tl270D 0627201705:46 0741r201722:22 SR Cemftcatan.. CTDOH.NELSC-NY IOg54.NJDEP.PADEP 854)1.8 Phenanthrenc ND ughg dry 47 7 95 1 2 FPA 8270D 06_7 ».,,' 201'OS.M 0741201'...__ gg ( Mrkowaa ("rD0H.NELA('-NY Ioa54.N11)SPPADEP ION-95.2 Phenol ND ugkg dry 47] 951 2 EPA 92701) 06'27.201705:46 0101Q01"2212 SR C'emftcau- CTD0II.NELAC-NY10854.NJDEP.PADEP 12941041 IN Tene ND ugkg dry 47.7 911 2 EPA 11270D 0&27,-201-0546 07,011201722:22 SR ('aufrcuron. Cit)CHI.NELAC-NYI0354.NIDEP.PADEP I10-ah-1 Pvndine ND uFAS dry IOn 381 EPA N2'OD 0627.201705.46 0741201722:22 SR (:ertriw.uan, CTDOH.NELAC-NYins$4.NJDEP.PAI)EP Surrogate Recoveries Rash Acceptaaee Range 367-124 Surmgair-1-Flimimphenol 73 9". 10-I NY 4163.62.2 Sumrgate.Phenol-OS 70.5". 23.114 41654" Surrogate Nitmben_ene-dS 64.2". 21-108 321.we Sun jtote 2-17uorobiphenv1 523% 21-113 d 1 s-79.6 Surrngule 2.4.6-Trlbtnnuil Aenol 84.0% 19J10 1719.5141 Surrogate Terphen0414 58.5% 21.116 Total Solids Loe-in Notes: Sample Notes: S-Ple Prepared by Method:n Solids Prep Rem° Date/Ilme CAS No. Parameter Result Flag UWts LoQ Dilution ion Reference Method Pretaand Aalllymd Analyst ed,d. %Solids 97.7 0.180 , 0627QOI711:39 062aR01713:5N LAJ nnh,o.n. o TDoH 120 RESEARCH DRIVE STRATFORD CT 06615 ■ 132-02 89th AVENUE RICHMOND HILL.NY 11418 www YORKLAB corn (203)325.1371 FAX(20.11 357-0166 CbenlServrces Page 9 of 13 r 1 Volatile Analysis Sample Containers Lab ID Client Sample ID Volatile Sample Container 17FO857-01 1 ?oz.WM Clear Glass Cool to V C 120 RESEARCH DRIVE STRATFORD CT 06615 0 132-02 891h AVENUE RICHMOND HILL,NY 11418 www YORKLAB corn t203)325-1371 FAX(2031 357-0166 ClientServlces Page 10 of 13 I Notes and Definitions VOA-CONT NON-COMPLIANT-the contamer(sI provided by the client for soil volattles do not meet the requirements of EPA SW846-5035A. Results reported below 2W ug kg may be biased low due to samples not being collected according to EPA SW946 3035A requirements. J Detected below the Reporting Limit but greater than or equal to the Method Detection Limit IMDL LOD)or in the case of a TIC.the result is an estimated concentration. i CCV-E The value repined is ESTIMATED. The value is estimated due to its behavior during continuing calibration verification(>209/. Difference for average Rf or>2064 Drift for quadratic fit). B Analyte is found in the associated analysis batch blank.For volatiles.methylene chloride and acetone are common lah contaminants. ' Analyk is not certified or the state of the samples origination does not offer ceruricatao for the Analyte. ND NOT DETECTED-the analyte is not detected at the Reported to level 1 LOQ RL or LOD IMDL) RL REPORTING LIMIT-the minimum reportable,-slue based upon the lowest point in the analyte calibration curve. LOQ LIMIT OF Ql:ANTITATION-the minimum concenuation of s target analvte that can be reported within a specified degree of confidense This is the lowest point in an analyte calibration curse that has been subjected to all step,of the proeessing/analysis and verified to meet defined cntcna-This is based upon NELAC 2009 Standards and applies to all analvses LOD LIMIT OF DETECTION-a venfred estimate of the minimum concentration of a substance in a given matrix that an analytical Process can reliabl, detect. This is based upon NELAC 2009 Standards and applies to all analyses conducted under the auspices of EPA SW-846. MDL METHOD DETECTION LIMIT-a statistically dens id estimate of the minimum amount of a substance an analvucal system can reliably detect with a 991.6 confidence that the concentration of the substance is greater than zero. rho is hexed upon 40 CFR Pan I t6 Appendix B and applies oniv to EPA 600 and 2W series methods. Reported to This indicates thin the data for a particular analysis is reported to either the LOD'MDL,or the LOQ/RL. In cases w here the"Reported to"is located above the LOD.MDL.any%slue between this and the LOQ represents an estimated value which is"1'flagged accordingly.This applies it),olaule and semi-volatile target compounds only NR Not reported RPD Relative Percent Difference Wet the data has been reported on an as-received(wet weight)hags Low Bias Low Bus flag indicates that the recovery of the flagged analyze is below the laboratory or regulatory lower control limit. The data user should Wee tale that this analytc maybe biased low but sbtuld evaluate multiple lines of evidence including the LCS and site specific MSWISD dais to draw bias conclusions In cases where no site-specific MS MSD was requested.only the LCS data can be used to evaluate such bias. High Bias High Bias flag indicates that the recovery of the flagged analyte is above the laboratory or regulatory upper control limit The data user should take note chat this analyte may be biased high but should evaluate multiple lines of evidence including the LCS and site-specific MS'MSD data to draw bias conclusions. In cases where no site-specific M&MSD was requested only the LCS data can be used to evaluate such bias Non-Dir. Non-din flag(Non-Directional Bias)indicates that the Relative Percent Difftrenct IRPD)la mealtime of precision among the bIS and MSD data t, otiside the laboratory or regulatory control limit. This alerts the data user where the MS and MSD are from site-specific sample,that the RPD is high due to either next-homogeneous distribution of targn analvic hOween the MS MSD or indicates poor reproducibility fit other reasons. If EP.4 SW-846 method 82?0 is included herein it is noted that the target compound N-mirosodiphenylamtne INDPAI decomposes In the gas chromatographic inlay and cannot be separated from diphcnvlarnme(DPA). These results could actually represent loot.DPA.100%NDPA or sure combination of the two. For this reason.York reports the comhined re,ult for n-nitrosidiphenylarnme and diphenylamme for either of ibese compounds as a combined concentration as Diphanylarnme. if Total PCBs are detected and the target aroclors reported arc"No detected". the Total PCB value is reported due to the presence of either of both Aroclors 1262 and 1268 which are non-target aroclon for suns regulawry lists 2-cMarnethylvinyl ether readily breaks dour under acidic conditions. Samples that arc acid prcurved.including standards will exhibit breakdown.The data user should take rroe. Ceniftation for pH is no longer offered by NYDOH FLAP 120 RESEARCH DRIVE STRATFORD CT 06615 1111 132-02 89th AVENUE RICHMOND HILL NY 11418 www YORKLAB.com (203)325.1371 FAX(203)357-0166 ClfentServices. Page 11 of 13 1 Semi-Volatile and Volatile analyses arc repuned doe n to the LOD NDL.with%aloes between the LOD,MDL and the LOQ being"I"flagged as estimated results. For analyses by L'PA S W-846-1270D.the Limit of Quantitalioii t LOQI rgwned for benzidine is based upon the lowest standard used for calibration and is not a verified LOQ due to this compound's propaysiq for oxidative losses during extraction concentration procedures and non-reproducible chromatographic performance 120 RESEARCH DRIVE STRATFORD CT 06615 a 132.02 89th AVENUE RICHMOND HILL NY 11418 www YORKLAB com (203)325-1371 FAX(2031357-01,66 ChentServices Page 12 of 13 N I I I I I I w s O Q �` I I $ a� \I v 6 CD \ CI aC 3 �10 � m �' a p EVUay � CrnOLau I�Ln m� � z0o2- Wt� I r1 n� Yw '• s. w r w co 5 E arc cc a a o�c `o g J' O eVc L� z g c �° E co W ` yg mat I y cr .Y 8r r 6 G CJ y C� I N H •Waft � O eL Y. 6++ ca i E 3 ac _is allow, CA Y �` s HS3oe << a U. CL v �, a .31 j� a p m C Zt 7W O 3 a c l r ATE(MM/DD/YYYY) ACORV CERTIFICATE OF LIABILITY INSURANCE 4/17/2017 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 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 NAME: Aaron Epstein Westrock Insurance Agency PHONE , (845)638-2300 FAX No:t845)638-5222 151 North Main Street AIL .Aaron@westrockinsurance.com __ADDR Suite 204 INSURII AFFORDING COVERAGE NAIC0 New City NY 10956 INSURERAMerkley Insurance Company 32603 INSURED INSURERB:Selective Fire & Casualty Insurance 14377 Mike Hoensch Tank Company Inc. INSURERC:Selective Insurance_ Company of New 13730 PO Box 428 INSURERD: 50 Spanktown Road INSURER E: Warwick NY 10990 INSURERF: COVERAGES CERTIFICATE NUMBER:CL174304753 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IXP LT R TYPE OF INSURANCE mrn SUER POLICY NUMBER MM/DD EFF POLICY MM1DD YYYY LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ RENTED A CLAIMS MADE F% OCCUR DAMMI E T a occurrence) $ 50,000 E Pollution Liability X FEI-ECC-14039-04 3/27/2017 3/27/2018 MED EXP(Any one person) $ 5,000 % Professional Liability Occurrance Form PERSONAL III ADVINJURY $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: Claims Made Form GENERAL AGGREGATE $ 2,000,000 POLICY PRO - LOC 2,000,000 PRODUCTS-COMP/OPAGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ 1,000,000 Ea accident B ANY AUTO BODILY INJURY(Per person) S X AUTOS AUTOS X ALL OWNED SCHEDULED S 2205777 3/11/2017 3/11/2018 BODILY INJURY(Per accident) $ . _ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist Drooertv $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED 1 1 RETENTION$ $ 'WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TAT T R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMIPLOYE0$ f yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S C INLAND MARINE S2057945 3/27/2017 3/27/2018 7 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) additional insured:Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Avi Epstein/ALEXA C% ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ,n,4,� STATE OF NEW YORK CERTIFICATE OF WORKERS' COMPENSATION BOARD NYS WORKERS'COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) Ib.Business Telephone Number of Insured Mike Hoensch Tank Company,Inc. (845)544-2330 dba MH Tank Co 1 c.NYS Unemployment Insurance Employer Registration PO Box 428 Number of Insured Warwick,NY 10990-0428 Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured or limited to certain locations in New York State,i.e.a Wrap-Up Policy) Social Security Number 204463943 2.Name and Address of Entity Requesting Proof of Coverage(Entity 3a.Name of Insurance Carrier Being Listed as the Certificate Holder) Continental Indemnity Co. Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street Rye Brook,NY 10573 46-868245-01-OS 3c.Policy effective period 04/01/17 to 05/16/17 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A 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'. Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? ®YES ❑ NO 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 Certifi- cate 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 form Approved by: Todd Brown (Print name of authorized representative or licenced agent of insurance carver) Approved by: 04/19/2017 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: (877)234-4424 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-15)