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Home My WebLink AboutMP14-066 B G tCWo j of i t VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E.Fews David M.Heiser Donald T.Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 28,2025 Pak Yun Chan&Jaclyn Chan 745 King Street Rye Brook,New York 10573 Re: 745 King Street,Rye Brook,New York 10573 Parcel ID#: 136.29-1-16 As per the Certification letter from Grazi 1 Corp. Environmental Contractors, received April 28, 2025, the removal of an underground oil tank under Mechanical Permit #14-066 issued on 6/16/2014 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRC�j�, . 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 : 7 L/-5 Imo- i N V C DATE: x PERMIT# M P 14 -()(0(.0 ISSUED: (O'} 7 SECT: 13 , Z 7 BLOCK: LOT: � LOCATION: 1 R/ 'j k Q! 'A ht op d' V`e IN OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... El'-"ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION r ❑ NATURAL GAS r Lx f "c- ❑ L.P. GAS R FUEL TANK ❑ FIRE SPRINKLER - ❑ FINAL PLUMBING Y ' (' ❑ CROSS CONNECTION � 1 ` ❑ FINAL ❑ OTHER Re B 190.2 . BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAx(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - --- - - --- -- ADDRESS: l vl� �� DATE: J PERMIT# � ISSUED: l SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACC TED ❑ REJECTED/REI PECTION O SITE INSPECTION �� in)Ice UIRED 0 FOOTING 0 FOOTING DRAINAGE 0 FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING 0 INSULATION ol ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER �� •�.`�\ � S\ c �F ��( �� 0 FINAL PLUMBINGo FINAL ❑ OTHER ��-- c��C,y Q �� cam- a O � O N Q •``� •'r � .K �t w � L0 ` o W CYC6 xOc I� a� �•I CLRo N ti = W W � o 03 � c � Zkr) Q � 'o cd a' � o A ■ o 4 ' M z o " � ' ° � = •r 'n f-.-I O COD ,�/ 'M—�l � .ice � •� 2. ;a .0 r_ a/ ao z k M■d■■� 00 ton" p o n c o V W oo00 tn U O oo MCI Z A A H z °2 �V , y > 0 c 0 u � w M � � � q x v „ Q •� � Q ° (u `' :o F W z z 2 w aJL 0 0 0 ^^W C a) D �I 3 V � �i �, a' EE z � U !! O W F �'•7 O 0 W cras 0. cm p EC� ENE VILLAGE OF RYE BROOK 0 BUILDING DEPARTMENT 6 2014 .1n — 938 KING STREET,RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FAx:(914)939-5801 www. ebrook.o BUILDING DEPARTMENT APPLICATION FOR PERMIT T MOVE BANDON AND/OR INSTALL FUEL STORAGE TANK 00 GALLON CAPACITY (*Storage tanks in excess of 1100 gallons require registration with the Coun of Westchester) Permit#: t''1 L) P Building Inspector: Fee Paid: Date of Approval: 1 6 2014 (fees are non- efundabl REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded, Licensed Contractor 2. Copy of Licensed Contractor's Liability& Workers Compensation Insurance (naming the Village ofR as Certificate Holder) 3. Fee per Tank: temoval Abandonmen •�$17 , Installation: $175.00 4. Dig Safely New l 811): (/j-Q q 5. Inspection by Building Department for removal/abandonment & installation 6. Submit all Manifests& Reports(after work has been completed) 7. Certificate of Compliance will be provided when all requirements are fulfilled. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the removal,abandonment and/or installation of a Fuel Tank(s)herein described.The applicant,bysigning this document agrees that said Fuel Tank(s)will be installed,abandoned and/or removed in conformance with all applicable Local,County,State &Federal laws,codes,rules&regulations. Indicate either above ground tank or buried in-ground tank. 1. Property Owner's Name: �'�leery '4eenn,5 Sl�mPhone#: 2. Job Address: y K� _� -L?_ zA-Phone#: �l 3 3. Parcel I.D. #: 3(p, a 9 - I Zone: 4. Contractor:G�iaZx C-0,�o Phone#: 395-a7$ T$-97( 5. Contractor's Address: OL-,t-�p [sj & >�ax#: 7945- 3-72L33 9 6. Exact location of tank to be Installed: above ground in ground iJ 7. Exact location of tank to be Removed: above ground _ in ground 8. Exact location of tank to be Abandoned: in ground only 9. Distance of Tank from Structure: 10. Distance of Tank from Property Line: 11. Type of Fuel: Oil:[,,, Propane:❑; Gasoline:El: Other: 12. Number&Capacity of Each T \ 55Dq4 05A Signature of Applicant: Date: (D Printed Name of Applicant: Phone#: W14Y- W- r 6.l.zo1a Jun 13 14 03:05p Grazi 1 Corp. 8452788899 p.1 -GRAZ HRI�3 to�77axLD�t�-i& � O P.�FSi2.' Ta 0 - - 7 2 T= awkaRoaa-aevester,w7u� i email: melissa@grazilcorp.com email: mike@grazilcorp.com Date: Attention: Notes: J J Q , I A A--*" rljy-)LA Q Thank You! Number of Pages/ Including Fax Cover Visit Us On The Web at www.grazilcorp.com s -.-. + 4 + _ K.I _ • E _ _ - , = - -- - - I ` - , ,ems---.—_ SE]� �- _ `"'F- - _ .:_..l..-«� -—.3._t.. ....i_ .__. --..:.... .__3—.s—--i-- ---F•—?•».�. ._.�. , . s . 1 _T '1 , _ ' t - , _ 1 Z'd 66999ZZ968 'daoo iZ8JC) dgo'.Cot, £l unf RA GZ � GRAZI 1 CORP.TAX I.D.#06-1623910 R •1 W.C.LICENSE#15101-H04 P.C.LICENSE#2582-A 215 Tonetta lake Road FIIV1TOe pn�'a p Tank Removal Installation&Remediation Road V 845.278.9600 www.GrazilCorp.com V 845.278.8898 F 845.278.8899 July 15, 2014 Mr. John 0' Dee D ��,------- New York State Department of lL�_" Environmental Conservation Bureau of Spill Prevention and Response APR 2 8 2025 100 Hillside Ave Suite 1W VILLAGE OF RYE White Plains, NY 10603 BUILDING DEPAaTM8t+T Re: Kiyak Residence S 745 King street pill #:1401330 Rye, NY 10580 Mr. O' Dee, The objective of this letter is to summarize the underground storage tank (UST) removal and soil testing, performed by Grazi 1 Corp. at the address listed above, as well as provide all relevant information required by your office. On June 26, 2014, Grazi 1 Corp removed one (1) 550 gallon UST, that had a failed tank tightness test on May 8, 2014 from the site address listed above. The UST was used to store #2 fuel oil to heat the building. The 550 UST was replaced with a 275 gallon temporary AST, installed by Robison Oil, until homeowners convert to natural gas. Copy of Certificate of Completion of tank test enclosed. The 350 gallon UST was cut and cleaned by Grazi 1. All residual product and sludge was removed by a vacuum truck. The cleaning process generated 60 gallons of waste product which was then transported by Enviro Waste Oil Recovery, LLC for proper disposal. A copy of receipt enclosed. Grazi 1 then removed the 550 UST from the ground. Grazi 1 did an inspection for holes or other compromises in the tank' s anatomy, none were found. Grazi 1 found no visual signs of liquid petroleum impact in the tank grave. A composite sample was taken of all four walls and the base of tank grave. The sample went to Phoenix Environmental Labs, in Manchester CT for analysis. G RAZ I ,//�/ R P• GRAZI 1 CORP.TAX I.D.# 3910 W.C.LICENSE#15101-H04-H04 P.C.LICENSE#2582-A EI1V1ILake Road COntracto 'g Tank Removal Installarion&Remediation 215 Tonetta take Road V 845.278.9600 www.Graz1VCorp.com V 845.278.8898 F 845.278.8899 The samples passed DEC criteria, a copy of the analytics are enclosed. After samples were taken, the site was then back filled and returned to grade. The 550 gallon UST was taken off site and brought to Southeast Auto Recycle, Inc. for disposal, receipt enclosed. Grazi 1 Corp. on behalf of Kiyak Residence, request closure of the NYSDEC Spill Case number 1401330. This request is based off the absence of petroleum release in tank grave as well as the laboratory data enclosed. Sincerely, Vincenzo Graziano Grazi 1. Corp r : I , ; ' t , : i x : ryi i ! _'• i '-• i i { , � _�._...... ..>,.—.. 1.-.-y_ ...i..,_�.. .....-.. .3.._....._..._i__. 1 ._ +r _ i �• : L + -I: Y ....:_.... ._•_.T,'_'_'�••'1•--:._'!(._.{.....�....j.._„j,_..:.._. _ _ t._{__ _ i �I —;�'f'K--1�._t.-.i_._._,�._A._..x,._.i— ____�_•„1,.� E .. a y.... 1 i y—'` ^j--. �` I.....'_... S ! : _.}•-. I f i 1 - 14 - : i � • x t �t fu • i F ! -ti i „_y_•_•F jam_; r 1 { — — ° : �_ t i _!• .�y• + i.:�:,}�... _..¢_.I --7— II [ IL y t - y ; � F . . r .I ! ...... ...:... i , ..-..t_LL. - . t .j}f . 1 r 4.,. ENVIRO.WASTE OIL RECOVERY,LLC: 279 Route 6,O'O.Sox 747 Ea,,, Sales Order Nu116er-.:-236692 Mallcpac,_NY 10541 I '� � �E�� Sales Order Date: 6124H4 Ph. (845)279-0263 L VCTUE Fax: (845):621-3075 Page:, SoLDTO- GRAZI I CORP. SHIP TO: Az, `t t:ORP:JO$SITE 215 TON ETTA LAKE ROAD 745#ClNG`STREET BREWSTER,NY 1I��9 RYA,NY 10580 . CUSTOMER ID P N' ER ��. 1_27 1}� SAL NAME - H USE cm T SHIPPING METHOD - _ PAYMENT-TERMS: DESIGNATED FACILITY ENVIRO WASTE OIL RECOVERY - - - 279 RT$,hriRHOPAC NNY 10541 STATE ID NO ADDRESS USA EPA ID NO NYD0448256,-,6 QUANTITY ITEM DESCRIPTION �f T�� 01LY WATER DISPOSAL UNIT COST TOTAL -t�1 71]$}a SLUDCEf1VACUUI•A SOLID 71411 USED OIL DISPOSAL 7.46 VAC SERVICE 7418 VAC TRUCK HOURLY RATE VAC OUT 6124 Q 10:30 AM FROM 550 Subtotal Sales Tax 1,7. . Total 7 I i _ W/w FILTERS W/O W�A/F C IAg0E MYACCOUNT:FOR•TI.IIS:TRANSACTION:UNLESSIDTHERWISE:INDICATED IN THE PAYMENT SECTION.j, O CES REFLEC W SSE -ORSHA L.Be . TI MONTH(iB°%PER'ANNUM)OR.iHEMAXIMUM RATE-ALLOWED BYLAW ON ANY•INVOIC S.THAT AREryO�i. 1 - ORDA SIN THE EVENT O.RDEFAULT,ENV RO WASTE SHALL.Be TO RECOVER COSTS OF COLLECTION,INCLUDING,REASONABLE ATTORNEY'.^,FEES:'-INITIAL;- __" - NY00446IIE636 �' • US DOT DESCRIPTION ONIA/NEFi$ 701AL U,VI NO. TYPE QUANTITY WTNOL • � VI �� I ) - PETROLEUM CONTAMINATED WATER, NON C.O.T., NON R.C.R.A 0 a� FETROLEUM CONTAMINATED SLUDGE, NON D.Q.T., NON R.C.R.A GENERATOR WARRANTS REPRESENTS THAT THE MATERIALS PROVIDED EN1RR0 WASTE HEREUNDER HAVE NOT BEEN MIXED,COMBIIVEQOR OTHERWISE ICEATIPYTHAT MYTOTALWASTE STREAMS I BLENDED IN ANY OUAN7ITY WITH MATERIAL$CONTAINING POLYCHLORINATEp BIPHENYLS(PCB)OR ANY OTHER MATERIAL DEFINED AS HAZARDOUS WASTE ARE WITHIN ONE OF THE FOLLOWING UNDER APPLICABLE LAWS,INCLUDING BUT NOT LIMITED TO{O CFR PART 261.GENERATOR AGREES TO INDEMNIFY AND HOLD ENVIROWASTE HARMLESS FOR -CATEGORIE& ANY DAMAGES.COSTS.ATTORNEY'S FEES,ETC.ARISING OUT OF OR IN ANY WAY RELATED TO A BREACH OFTHE ABOVE WARRANTY SYTHE GENERATOR, ENVIRO WgS7E.ITS AGENTS AND CONTRACTORS HAVE THE CAPACITY AND ARE AUTHORIZED AND PERMITTED IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS.TO TRANSPORT ACCEPT.STORE.RECLAIM OR AND/OR DISPOSE O THE WASTE LISTED ON THIS DOCUMENT 0TO 220 LBSngpNTH GENERATOR CERTIFIES THAT THE WASTE IS:D USED OIL D USED ANTI-FREEZE 7 OILY WATER ]OTHER IMTIAI,S 22O LSSTO2.200 LBS/MONTH DEXSIL CDT INS >.H,nm2 TEST RESULTS GREATER THAN 22W LBSAAONTH o wre . GENERAMP,gUSTOMER PpM INRW$ 07/15/2014 10:19 FAX 8458323103 Z 001/001 Ow SOUTHEAST AUTO RECYCLE, INC. Sad # 4 1492 ROUTE,22re W es Receipt INGDAI.E,NY 12594 Date Sale No. 845-832-9448 7/9/2014 29615 GRAZIANO CORP. Description Qty Rate f5l'ANKS NI'RFP S'1'FiF.I. Amount 550 GALLONS 6,680ANK 1,000 GALLONS 2 'TANKS 275 GALLONS 1 TANKS 330 GALLONS It is the customers responsibility to double check their ticket before leaving the office to assure that all material was accounted for. Total FAX# E-MAIL WEB-SITE NOW YOU CAN CHECK F. OUT OUR SCRAP 845-832-3103 R Q@SOUTHEASTNY.COM WWW.SOUTHEASTNY.COM METAL PRICES ONLINE! 05/09/2014 11:49 8458553971 US TANK TECH �'. PAGE 05 (DISPLAY 8Y TANK) CERTIFICATE OF COMPLETION PRESENTED TO CHAN,JA.MES (CUSTOMER) FOR THE COMPLETION OF A PRECISION "TIGHTNESS"TEST-ON AN UNDERGROUND STORAGE TANK SYSTEM IN ACCORDANCE WITH LOCAL, STATE& FEDERAL REGULATIONS AND ORDINANCES. 5/F/2n 14 DATE OF TEST _TEST METHOD HORNER E7_Y 3 LP PLACE OF TEST 745 KING STREET RYE BROOK NY 1057- DESCRIPTION OF TANK Tank ID: I 550 CALLON P2 NF,ATTNG FUEL OIL FATL RESULT CONFIDENCE LEVEL 45 I<ET17i SiNiST'ORE U.S.TANlCTEOH P.O.BOX 34� License>= \ CARM. F.l...NY 10512 5PTLL9 44.01330 — - PAS#: 0-o00000 PrMflnn To�Nng,a•.de(irKd pry the Napoml Firc Prorattipat Asso:iation(r�TPA 12J1,means a Irst drat akan inm eaaaideagdon N:trmtpcmn�m mel!'elent of %9tD of the produce boinp reared n%Rhtni to the tempo aamr chmpe dudnp Ue ttst nttd tS e+p+ble of oNaednR s Inra of+/-0,05 10,(MM gniton m,amntltt mnk aysiem, golkn1 per hour in e, ens collarle ET_Y3LP tank system thnuld not be declared tight if;uc,mtic signal detected is diflefent frntn the $� baseline signal ohhlncd before vacuum is pinecd on The tank,or ifwpltt ingress is deteeteel pry aatcrRensor. rode%can I ar o v �Snn)snnl)siv Indicates- TANK FNI_S WITHIN C.P.A.UU10FL NES y Rttctnntcndnllvn•r d, g 3 5 RlMnimerat Many focmo affect the rccuhs of rwalRlnn Ir"InR nr underground tanks including•but not limited to,enlmpged air-vapor pockeu. ,voter tnhle vhriatimlR unksnd dcflcettom.product npnn%lon rind contraction. wind,evnpnrmlon,hommeWe proscuro,qc. Contraelor'R pergnnnnl rim learned to I'miersmnd and,where posible to adjust far there fnetots dnHnp the perfmmanee of a prccicinn Ipt. However,some of to fncinn may not he ennuollnhle and Iherefom.the Contractor DOF9 Nfyr FX?itFSS OR IMPLY any warmna�y ar puanntca to the accmacy of the remits The Conorclor's Sole,nli CRCll ova n'otmaly tR that rile ConoaclWA Inalrume nadon has iha prealelon accc,—y,.meal NFPA 14 critcdn and is nn ncceptnblo irti mclline. The reauln of the Contmcinr'R tell are,nniy valid nndcr the gleclRc nprmdngg conditions of the prmsion test nmi mly ripply to the conditions of tlm undegmuml Innk.+;the rime of the test. Tim Cnntmeror DOES NOT 0NPRRSg OR IMPLY lav pna or From rcponelhillty nR m the cnntNll!m of rha umlermm�nA rank system. Forthermom,the ContrlKlhrla not rcsnM%ihie for any an-gning Icalenpo below the Ifmid of the { measurement nccumcy of rite icsting mohnel, Y Indemnity: Cil tanner wig indomnliY.rtorond,and hard Camracinr harmicss Ram any IoAx.damage.auks.Pcnnhiaa,cwq,Iinbilifias and ekp"(idciuding,bat not Ilndted to,remnnahle InvnllRatinn and icient eapeme%)arising oat of anyg101m for isms or dnmag^to property, hgmnn henilli or the environment. Thin Ilmlt►tion of Cnntracmr'a liability inc)utim bill Is not Ilmltea[lo.no liability for any apllls•leaks,or dtsehargps or nny%ubtlmtcr to it,,envmmment and the cost of clenn.op,mmediol ncilon or any caber cost.eirpelim nr damage Rom soch spills. lank o•dlscll,rgn., NnQcoc Roguln0orm regpire Ihm notice be Siren in doe event or.,%pill or of a foiled precision test. Tn NYS the DCC must be natlfted within 2 hono by the rnnrmcmr. In CT the DEP mna M:noliped within 24 boars cg+ly In Ilan ante of n spill. Taallna Crnlile+.te:Thin prtelalon rnnngsmifiann Mould be.mnleWned by lhrohaR of lbe fseiliry Tills Ccni Rcm shwld be disDlayad in a pmmine,a new near tic e+nk sysrtm. Ccyydght O Pmtca.d.All Rishc%Rc crv�d PH0EVX`-,,ns',�4,.` _ Ell VironInenlul faborwories. Inc. Wednesday, July 09, 2014 Attn: GRAZI 1 Corp. 215 Tonetta Lake Rd Brewster NY 10509 Project ID: 745 KING ST., RYE BROOK Sample ID#s: BG68970 This laboratory is in compliance with the NELAC requirements of procedures used except where indicated. This report contains results for the parameters tested, under the sampling conditions described on the Chain Of Custody, as received by the laboratory. All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. A scanned version of the COC form accompanies the analytical report and is an exact duplicate of the original. If you have any questions concerning this testing, please do not hesitate to contact Phoenix Client Services at ext. 200. Sincerely yours, Phyllis Shiller Laboratory Director NELAC -#NY11301 NJ Lab Registration #CT-003 CT Lab Registration #PH-0618 NY Lab Registration #11301 MA Lab Registration #MA-CT-007 PA Lab Registration #68-03530 ME Lab Registration #CT-007 RI Lab Registration #63 NH Lab Registration #213693-A,B VT Lab Registration #VT11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06040 P� Telephone(860)645-1102 Fax(860)645-0823 Iff UF `, � Environmental Laboratories, Inc. 587 East Middle Turnpike, P.O.Box 370, Manchester,CT 06045 NY 4 1 1301 Tel. (860)645-1102 Fax(860)645-0823 SDG Comments July 09, 2014 SDG I.D.: GBG68970 BG68970- Client provided soil jar for volatile analysis. Phoenix prepared sample per method 5035. '`—WO rll Environmental Laboratories, Inc. . . n i 587 East Middle Turnpike, P.O-Box 370. Manchester,CT 06045 '�`! �/ ' 1'Sli 1 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: July 09, 2014 GRAZI 1 Corp. 215 Tonetta Lake Rd Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: MG 06/30/14 0:00 Location Code: GRAZI Received by: LB 07/02/14 17:04 Rush Request: Standard Analyzed by: see "By" below P.O.#: STERN Laboratory Data SDG ID: GBG68970 Project ID: 745 KING ST., RYE BROOK Phoenix ID: BG68970 Client ID: BASE COMP RL/ Parameter Result POL Units Date/Time By Reference Percent Solid 85 % 07/02/14 Soil Extraction SVOA PAH Completed I 07/02/14 NB/F SW35 SW3545 Volatiles- STARS/CP-51 1,2,4-Trimethylbenzene ND 1.2 ug/Kg 07/09/14 1,3,5-Trimethylbenzene ND 12 Al SW8260 ug/Kg 07/09/14 JLI SW8260 Benzene ND 2.4 ug/Kg 07/09/14 Ethylbenzene ND 2.4 Al SW8260 ug!Kg 07/09/14 JLI SW8260 Isopropylbenzene ND 1.2 ug/Kg 07/09/14 Al SW8260 m&p-Xylene ND 2.4 ug/Kg 07/09/14 Methyl t-Butyl Ether(MTBE) ND 1.2 Al SW8260 ug/Kg 07/09/14 Al SW8260 Naphthalene ND 1.2 ug/Kg 07/09/14 Al SW8260 n-Butylbenzene ND 1.2 ug/Kg 07/09/14 JLI SW8260 n-Propylbenzene ND 1.2 ug/Kg 07/09/14 JLI SW8260 o-Xylene ND 2.4 ug/Kg 07/09/14 Al SW8260 p-Isopropyltoluene ND 1.2 ug/Kg 07/09/14 Al SW8260 sec-Butylbenzene ND 1.2 ug/Kg 07/09/14 Al SW8260 tert-Butylbenzene ND 1.2 ug/Kg 07/09/14 Al SW8260 Toluene ND 2.4 ug/Kg 07/09/14 Al SW8260 Total Xylenes ND 2.4 ug/Kg 07/09/14 JLI SW8260 QA/QC Surrogates % 1,2-Dichlorobenzene-d4 95 % Bromofluorobenzene 93 % 07/09/14 At 70- 130% % Dibromofluoromethane 111 % 07/09/14 07 JLI 70-130% u 98 09/14 Al 70-130 /o Toluene-d8 07/09/14 JLI 70-130 Semivolatiles-STARS/CP-51 Acenaphthene ND 270 ug/Kg 07/03/14 DID SW 8270 Page 1 of 2 Ver 1 Project ID: 745 KING ST., RYE BROOK Client ID: BASE COMP Phoenix I.D.: BG68970 RL/ Parameter Result PQL Units Date/Time By Reference Acenaphthylene NO 270 ug/Kg Anthracene 07103l14 DD SW 8270 NO 270 ug/Kg 07/03/14 DD SW 8270 Benz(a)anthracene NO 270 ug/Kg 07/03/14 DD SW 8270 Benzo(a)pyrene NO 270 ug/Kg Benzo(b)fluoranthene NO 270 07/03/14 DD SW 8270 ug/Kg 07/03/14 DD SW 8270 Benzo(ghi)perylene NO 270 ug/Kg 07/03/14 DD SW 8270 Benzo(k)fluoranthene NO 270 ug/Kg 07/03/14 DD SW 8270 Chrysene NO 270 ug/Kg 07/03/14 DD SW 8270 Dibenz(a,h)anthracene NO 270 Fluoranthene ug/Kg 07/03/14 DD SW 8270 ND 270 ug/Kg 07/03/14 DD SW 8270 Fluorene NO 270 ug/Kg 07/03/14 Indeno(1,2,3-cd)pyrene NO DD SW 8270 270 u9/K9 07/03/14 DD SW 8270 Naphthalene NO 270 ug/Kg 07/03/14 DD SW 8270 Phenanthrene NO 270 ug/Kg 07/03/14 DD SW 8270 Pyrene NO 270 ug/Kg 07/03/14 DD SW 8270 QA/QC A1122ates %2-Fluorobiphenyl 84 % Nitrobenzene-d5 07/03l14 DD 30- 130 69 % 07/03/14 DD 30-130% °o Terphenyl-d14 83 07/03/14 DD 30-130 RL/PQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quanitation) ND=Not Detected BRL=Below Reporting Level COMMents: This sample was not collected in accordance with EPA method 5035. NELAC requires the laboratory to qualify the volatile soil data as biased low. All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If there are any questions regarding this data,please call Phoenix Client Services at extension 200. This report must not be reproduced except in full as defined by the attached chain of custody. A)tiL Phyllis,6 hill er, Laboratory Director July 09,2014 Reviewed and Released by: Bobbi Aloisa,Vice President Page 2 of 2 Vert UUIT�§--. ==�" �H Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370, Manchester,CT 06045 NY 4 11301 QA/QC Report Tel. (860)645-1102 Fax(860)645-0823 JUIy 09, 2014 QA/QC Data SDG I.D.: GBG68970 LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank % % RPD % % RPD Limits Limits QA/QC Batch 278755,QC Sample No: BG68755(BG68970) Polvnudear Aromatic HC - Soil Acenaphthene ND 90 90 0.0 92 93 1.1 30-130 30 Acenaphthylene ND 94 93 1.1 96 96 0.0 30-130 30 Anthracene ND 78 97 21.7 101 100 1.0 30-130 30 Benz(a)anthracene ND 87 87 0.0 87 89 2.3 30-130 30 Benzo(a)pyrene ND 96 98 2.1 102 100 2.0 30-130 30 Benzo(b)fluoranthene ND 94 102 8.2 101 101 0.0 30-130 30 Benzo(ghi)perylene ND 88 86 2.3 87 86 1.2 30-130 30 Benzo(k)fluoranthene ND 95 94 1.1 105 101 3.9 30-130 30 Chrysene ND 99 97 2.0 98 101 3.0 30-130 30 Dibenz(a,h)anthracene ND 90 89 1.1 92 89 3.3 30-130 Fluoranthene ND 78 80 2.5 104 104 0.0 30-130 30 Fluorene 30ND 95 97 2.1 96 96 0.0 30-130 30 Indeno(1,2,3-cd)pyrene ND 91 90 1.1 92 90 2.2 30-130 30 Naphthalene ND 88 87 1.1 85 88 3.5 30-130 30 Phenanthrene ND 98 98 0.0 101 100 1.0 30-130 30 Pyrene ND 80 82 2.5 107 108 0.9 30-130 30 %2-Fluorobiphenyl 72 77 76 1.3 78 78 0.0 30-130 30 %Nitrobenzene-d5 82 79 78 1.3 75 80 6.5 30-130 30 %Terphenyl-dl4 99 84 89 5.8 111 114 2.7 30-130 30 QA/QC Batch 279215, QC Sample No: BG68883(BG68970) Volatiles - Soil 1,2,4-Trimethylbenzene ND 105 103 1.9 95 106 10.9 70-130 30 1,3,5-Trimethylbenzene ND 110 109 0.9 96 106 9.9 70-130 30 Benzene ND 107 107 0.0 89 105 16.5 70-130 30 Ethylbenzene ND 111 110 0.9 95 106 10.9 70-130 30 Isopropylbenzene ND 105 104 1.0 91 102 11.4 70-130 30 m&p-Xylene ND 107 107 0.0 95 106 10.9 70-130 30 Methyl t-butyl ether(MTBE) ND 114 116 1.7 93 110 16.7 70-130 30 Naphthalene ND 111 110 0.9 88 112 24.0 70-130 30 n-Butylbenzene ND 106 103 2.9 97 105 7.9 70-130 30 n-Propylbenzene ND 100 100 0.0 95 105 10.0 70-130 30 o-Xylene ND 107 106 0.9 94 107 12.9 70-130 30 p-Isopropyltoluene ND 111 108 2.7 99 108 8.7 70.130 30 sec-Butylbenzene ND 109 108 0.9 96 107 10.8 70-130 30 tert-Butylbenzone ND 104 104 0.0 93 104 11.2 70-130 30 Toluene ND 111 111 0.0 94 110 15.7 70-130 30 % 1.2-dichlorobenzene-d4 97 96 96 0.0 95 97 2.1 70-130 30 %Bromofluorobenzene 93 98 99 1.0 100 100 0.0 70-130 30 %Dibromofluoromethane 97 102 101 1.0 104 98 5.9 70-130 30 %Toluene-d8 100 102 103 1.0 102 104 1.9 70-130 30 Page 1 of 2 QA/QC Data SDG I.D.: GBG68970 LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank % % RPD % % RPD Limits Limits Comment: Additional 8260 criteria: 10%of LCS/LCSD compounds can be outside of acceptance criteria as long as recovery is 40-160%. If there are any questions regarding this data, please call Phoenix Client Services at extension 200. RPD-Relative Percent Difference LCS-Laboratory Control Sample LCSD-Laboratory Control Sample Duplicate MS-Matrix Spike MS Dup-Matrix Spike Duplicate Phyllis,5hiller, Laboratory Director NC-No Criteria July 04, 2014 Intf- Interference Page 2 of 2 N N y c m m Q = d 0 m � c J Q' m N >. m � m � � m � m E U Q ' N N'- U C m J yyyN� � N N m � O C O U U C 7 � m N E N y Q>_O O'C O O U O v � - N (� O m A\ N W m d C U ,J C �j m o a � c m m C9 m C 1� p m W Go -> E 00 0 Lo C� Q o 'L m y - r^ u �+ c m .i 0 V o v X W� m L—O iL C �c U E — 0 N � V cQ U.lu mcai mp c m m.m m E o'a o T° y a @ Z m.c c m 0 ° na x c � Eo � a m-- o m o N u$4 •T N W N T C U oh C u O UU� Z Z ¢ O U N pm m m m C y N Z 0 X $.y c = to a o c m N U cm Z LNo a y n IOEN W t ,tic Gq�� Environmental Laboratories, Inc. tj :i 587 Fast Middle Turnpike,P.O-Box 370,Manchester,CT 06045 NY 11301 Tel.(860)645-1102 Fax(860)645-0823 NY Temperature Narration July 09, 2014 SDG I.D.: GBG68970 The samples in this delivery group were received at 4°C. 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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 Patricia Feeley y - PF Northeast Brokerage Inc PHONE (845)223-8107 IAICFAX (845)227-8816 27 High Ridge Road ADDRESS pfeeley@pfnortheast.com INSURERS AFFORDING COVERAGE NAIC# Hopewell Junction NY 12533 INSURER A:Nautilus Insurance Company INSURED INSURER B:National Grange Insurance Grazi 1 Corp INSURERC:Hartford Insurance Company 17 White Lotus Road INSURER D' INSURER E Brewster NY 10509 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1421204968 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. I R TYPE OF INSURANCE SUER POLICY NUMBER MMIDDY POLICY EXP LT LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 100 000 X{ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE Fx�OCCUR ECP200053702 2/11/2013 2/11/2014 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X!; POLICY PRO- LOC S AUTOMOBILE LIABILITY ED ac dEentSINGLE LIMIT 1,000,000 B X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BlU3658J 12/23/201312/23/2014 BODILY INJURY(Per accident) S AUTOS AUTOS NON OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident Underinsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? N/A CU3658J 12/23/201312/23/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100,000 If ye cri s,desbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 C NYS Disability LNY815246 /1/2014 2/31/2014 A Pollution Liability ECP200053702 12/11/201312/11/2014 $1,000.00o DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rc ,kr Sehed.le,if more space is q.irod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village Of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Patricia Feeley/PATTY ACORD 25(2010/05) 91988-2010 ACORD CORPORATION. All rights reserved. INS075 onlnn=1 m Th. arnan—ma a i I—nre roniet.—i—1—of arnan STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name&Address of Insured(Use street address only) Ib. Business Telephone Number of Insured Grazi 1 Corp (845)278-8898 17 White Lotus Road lc.NYS Unemployment insurance Employer Brewster,NY 10509 Registration Number of Insured 06-44270 Work Location of Insured(Only required ifcoverageisspecifteally Id.Federal Employer Identification Number of Insured li►nited to certain locations in New York State, i.e., a Wrap-Up 06-1623910 Policy) or Social Security Number 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) National Grang Insurance Company Village of Rye Brook 3b.Policy Number of entity listed in box"la" 938 King Street WCU36581, Rye Brook, NY 10573 3c. Policy effective period 12/23/2013 to 12/23/2014 3d. The Proprietor,Partners or Executive Officers are ❑ included. (Only check box if all partners/officers included) x all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' 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 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"T'. The Insurance Carrier will also notes the above certificate holder within 10 days IFapolicy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums 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. Please Note: Upon the 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 form. Approved by: Joseph W. Pires (Print name of authorized representative or licensed agent of insurance carrier) t Approved by: _ (Signature (Date Title: President_ Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 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(9-07) www.wcb.state.ny.us