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HomeMy WebLinkAboutMP20-074 DR tc�4.°jJ�v t� w v L��+4 vuy 1q 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 April 10,2024 Jose Herrera 506 West William Street Rye Brook,New York 10573 Re: 506 West William Street,Rye Brook,New York 10573 Parcel ID#: 141.35-2-44 As per the Certification letter from Innov8tive Environmental Services Inc. dated November 5, 2020, the removal of an underground oil tank under Mechanical Permit # 20-074 issued on 6/25/2020 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BR(�k, cu � • �9�2 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 - - - - - - - - - - - - - - - - - - - - 1- ' 1 ADDRESS: S O � �P S Yy 1 I \i t%.�— 5 �uj DATE: 41 /0 ' Z V Z L/ PERMIT# ��P a - ISSUED: "Z5""Za SECT: l yI 3 5 BLOCK: Z" LOT' 5d/�/ LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 1C w v V 9 ` ❑ L.P. Gas l 114-v ZL , FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Q( J ❑ FINAL ❑ OTHER C_ C.[� S(l�Q �Q �O2 / 7 Z� e QyE BR��• cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR �SSISTANT 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* y� — <� ISSUED: u�� �W.(CT: BLOCK: LOT: LOCATION: , '� �` (' �''1 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/ REINSPECTION ❑ SITE INSPECTION �, , REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P._GAs t 'FUEL TANK P `❑ FIRE SPRINKLER —G�� 1�) l{��'`� 1 h,�� V ❑ FINAL PLUMBING ❑ CROSS CONNECTION ^ ( <=A G V 4 ❑ FINAL ❑ OTHER D FEC E, WE APR - 9 2024 N N ON4, 4 -ri � _BUILDING DEPARTMENT ENVIRONMENTAL SERVICES INC . November 5, 2020 John O'Dee New York State Department of Environmental Conservation Spill Prevention and Response aohn.odee@dec.ny.gov RE: Jose Herrera 506 W.William Street Rye Brook,NY 10573 Spill#2002859 Dear Mr. O'Dee, The purpose of this letter is to summarize soil remediation of an underground oil tank, performed by Innov8tive Environmental Services, Inc. (IES) at the above-referenced site, as well as provide all pertinent information required by your office. IES was contracted by Mr.Jose Herrera to complete the soil remediation of a leaking underground storage which was previously removed by another company. On September 28, 2020 IES began the remediation process by excavation ex-situ reclamation of impacted soil. The soil remediation performed by IES generated 21.73 tons of fuel oil contaminated soils. Petroleum contaminated soils removed during the remedial action were properly disposed of at Clean Earth of Carteret, 24 Middlesex Avenue, Carteret, NJ 07008. A waste manifest is included for your review. Following the remedial action, IES collected samples labeled 3 wall composite, North Wall, as well as a Bottom sample. The soil samples were collected from areas of the tank grave that exhibited the highest PID readings. The soil samples were collected into laboratory clean glassware, maintained at 4 degrees Celsius, and delivered to Phoenix Environmental Laboratories located in Manchester CT.The soil samples were analyzed by EPA methods 8260 and 8270. Laboratory analysis of the post excavation soils samples showed concentrations of target analysis to be non-detect or below the New York State DEC guidance values (CP -51). Copies of the laboratory analysis are included for your review. 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914)449-6608 Email: service@innov8enviro.com 6 1 NNOVt�T1N/ E ENVIRONMENTAL SERVICES INC . The tank grave was then backfilled with 19 yards of screened backfill brought in by Thalle Industries, located at Warehouse Lane South, Elmsford, NY. Once the tank grave had been backfilled,the UST was removed from the premises and recycled at Brookfield Resource Management located at 100 Lamont Street, Elmsford, NY. A scrap ticket is attached for your viewing. IES, on behalf of Jose Herrera, requests closure of the New York State DEC spill case number 2002859. The request for closure is based on the remediation performed laboratory data presented. Furthermore, IES is requesting closure of all open permits associated with this address. This report has been prepared for the use of the New York State DEC, Jose Herrera, and the Village of Rye Brook. Reasonable due diligence was exercised by the staff of IES Inc. and conducting the research and investigation necessary for the development of this report. The conclusions provided by IES in this report are based solely on the information reported in this document. Results of future subsurface investigations may result in a modification of the conclusion stated above.The conclusions presented herein are based upon the current regulatory climate in and may require a revision if future regulatory changes occur. This investigation and preparation of this report has been conducted in accordance with generally accepted practices. No other warranty, expressed or implied, is made. If you have any questions regarding this report, please contact Donald Feeney at 914-589-6299 or donnie@innov8enviro.com. Sincerely, Donald Feeney Project Manager Innov8tive Environmental Services Inc. 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914)449-6608 Email: service@innov8enviro.com rl W W �4 U U ) U N4 U) •rl � � U U) (M O M 4-4 O O O OD r-I 3 E+ 11 N 4-1 rI rI l0 U) O rl I O I ro .. .. Ln W O O \ . 0 0 C) H z a) 0 0 u� Qo O �o � - � N N CD l0 1n S4 -H �C ro 0 o a Oo �4 3 0 U M ) N N rI M (1) O 0 OO M cT r-I x �4 U) N N O a) N \ \ M U) • to M 01 61 O 0 4-) O >1 (N O O N h U) al a a) H �:5 U) �4 a) U O U) ro O 0 (a z a) h a) oq r I C7 S4 U E- ro 4-4 ro U 0 a a E-H z w (M z � O 4-) Lr) nG U) O 41 H . 1 a) x > E a4 ro z roCo ,J-1 W N W z S4 —i z -i �4 ODD N 41H a) —1 � ro O a > �4 -H € co U O ) 0 H � Ux44 O m A �UU 0 -W a > H 3 PU O .[ a) z coo U a U) w 4J U) M 1` z w 0 0 >1 € 'o �4 �4 (L) . (N O H U) �7 Lf) 1:4 ro H 41 N J 5 W �4 U) r' (o Q) O U) a) a) U U -�j a) �4 ro E 4-1 44 -H (1) 0 ro S4 U Ll (L) �4 - 4Cra 4J �4 H � ro a)a F- m � � € N U N U 0 > U � C7 e CLeANE-'.ARTH Manifest# 2380492 GLOBAL JOB NUMBER: lco z_ FACILITY APPROVAL NUMBER: Z6301 t I/E Plr4Mddlesex Check One: I.' Earth of Carteret ❑Clean Earth of Maryland El Clean Earth of New Castle [I Clean Earth of Greater Washington Avenue 1469 Oak Ridge Place 94 Pyles Lane 6250 Dower House Road Carteret,NJ 07008 Hagerstown,MD 21740 New Castle,DE 19720 Upper Marlboro,MD 20772 Ph:732-541-8909 Ph:301-791-6220 Ph:302-427-6633 Ph:301-599-0939 °s ❑Clean Earth of Philadelphia ❑Clean Earth of North Jersey ❑Clean Earth of Southeast Pennsylvania ❑Other 3201 S.61 st Street 115 Jacobus Avenue 7 Steel Road East e Philadelphia,PA 19153 Kearny,NJ 07032 Morrisville,PA 19067 Ph:215-724-5520 Ph:973-344-4004 Ph:215-428-1700 F Non-Hazardous Material Manifest (Type or Print Clearly) ` NERATOR'S NAME&SITE ADDRESS: GROSS WEIGHT: Cotii ns [:]Yards l TARE WEIGHT: C}5 3 ns ElYards , GENERATOR'S PHONE: NET WEIGHT: ons ❑Yards DESCRIPTION OF MATERIAL/SAMPLE ID AND LOCATION k 1,p1 I ti o GENERATOR'S CERTIFICATION/AUTHORIZED AGENT -Incomplete and/or unsigned manifests will cause the load to be delayed and/or rejected. I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable state law,is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law,is not a DOT hazardous substance as defined by 49 CFR Part 172 or any applicable state law,has been fully and accurately described above,classified,packaged and is in proper condition for transportation according to all applicable state and federal regulations. Name: �(� Title: \ '• 1 1 Signature: r Date and Time: TRANSPORTER Company: p l�cut Phone Number: Address: Y Truck#and License Plate: 5 SI pC IU y Driver: A i 1_1r v__ O SW Haulers Permit#: (Type or Print Clearly) (applicable state permit#) I hereby certify that the above named material was picked up at the si a liste above. Driver Signature: � Date and Time: DESTINATION 3 I hereby certifZZINV5, ve n ed material was delivered without incident to the faci ity noted above. Driver Signature: Date and Time: �,� I hereb certify that the abov material has been accepted at th t�ve �recce �facility. Authorized Signature: ate and Time: -- I FACILITY ITEM.CE WM500/PRO'S MICE MKING,WC.1-888801-1515 PAYMENT RECEIPT Brookfield Resource Management 100 Lamont Street Elmsford, NY 10523 914-592-5250 Receipt:1637512 Date:9/28/2020 Customer:69802 Time:12:52:52 PM INNOVATIVE ENVIRONMENTAL 392 COLUMBUS AVE VALHALLA NY 10595 ID Number Ticket:1662501 Weigh In:PM 2020 12:44.07 Operator:Diane D Weigh Out:9/282020 12:52:49 PM Commodity Gross Tare Net Price TOTAL$ Tanks 10.660 9.940 720 3 0000/CW 21.60 -------------------------------•---------------------------------------- Ticket Total: 21.80 No.of Tickets:1 EZCash Paid: $22.00 Payment hlethod:EZCash Round Amt: $0.40 Total Paid: $22.0 For current pricing,hours and contact information check us out on the web Lbrookfieldscrap.com Join Brookfield Scrap on Facebook @webuyscrap Q rAPR - PHOEVIX024Environmental Laboratories, I►rc. VILF BROOK BUILDING DEPARTMENT Thursday, October 01, 2020 Attn: Donnie Feenex Innov8tive Environmental Services 392 Columbus Ave Valhalla NY 10595 Project ID: 506 W WILLIAM ST RYE BROOK NY SDG ID: GCG87166 Sample ID#s: CG87166 - CG87168 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. This report is incomplete unless all pages indicated in the pagination at the bottom of the page are included. 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 are the client above and have any questions concerning this testing, please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. Sincerely yours, UL Phyllis hiller Laboratory Director NJ Lab Registration #CT-003 NELAC -#NY11301 NY Lab Registration #11301 CT Lab Registration #PH-0618 PA Lab Registration #68-03530 MA Lab Registration #M-CT007 RI Lab Registration #63 ME Lab Registration #CT-007 UT Lab Registration #CT00007 NH Lab Registration #213693-A,B VT Lab Registration #VT11301 587 East Middle Turnpike,P.O. Box 370, Manchester,CT 06040 Telephone(860)645-1102 Fax(860)645-0823 Page 1 of 14 P �o XN ACC0,90I PHOEVITE\�-��,,dq, y�� U 4 Environmental Laboratories, Inc. ` NY#11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference October 01, 2020 SDG I.D.: GCG87166 Project ID: 506 W WILLIAM ST RYE BROOK NY Client Id Lab Id Matrix 3 WALL COMPOSITE CG87166 SOIL NORTH WALL CG87167 SOIL BOTTOM CG87168 SOIL Page 2 of 14 % 4C �N LCC00,0 PHOENIX f U � Environmental Laboratories, Inc. Z 587 East Middle Turnpike,P.O.Box 370, Manchester,CT 06045 NY# 11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Donnie Feenex Innov8tive Environmental Services October 01, 2020 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 09/28/20 13:00 Location Code: INNOVAT Received by: B 09/29/20 16:00 Rush Request: Standard Analyzed by: see"By"below P.Q.#: Laboratory Data SDG ID: GCG87166 Phoenix ID: CG87166 Project ID: 506 W WILLIAM ST RYE BROOK NY Client ID: 3 WALL COMPOSITE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 92 % 09/29/20 CJ SW846-%Solid Soil Extraction for SVOA PAH Completed 09/29/20 K/M SW3546 Volatiles- STARS/CP-51 1,2,4-Trimethylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C 1,3,5-Trimethylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C Benzene ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C Ethylbenzene ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C Isopropylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C m&p-Xylene ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C Methyl t-Butyl Ether(MTBE) ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C Naphthalene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C n-Butylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C n-Propylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C o-Xylene ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C p-Isopropyltoluene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C sec-Butylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C tert-Butylbenzene ND 1.2 ug/Kg 1 09/30/20 JLI SW8260C Toluene ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C Total Xylenes ND 2.4 ug/Kg 1 09/30/20 JLI SW8260C QA/QC Surrogates % 1,2-Dichlorobenzene-d4 100 % 1 09/30/20 JLI 70-130% %Bromofluorobenzene 96 % 1 09/30/20 JLI 70-130% %Dibromofluoromethane 100 % 1 09/30/20 JLI 70-130% %Toluene-d8 98 % 1 09/30/20 JLI 70-130% Sem iolatiles-STARS/CP-51 Acenaphthene ND 250 ug/Kg 1 09/30/20 WB SW8270D Ver 1 Page 3 of 14 Project ID: 506 W WILLIAM ST RYE BROOK NY Phoenix I.D.: CG87166 Client ID: 3 WALL COMPOSITE RL/ Parameter Result PQL Units Dilution Date/Time By Acenaphthylene ND 250 ug/Kg 1 09/30/20 WB SW8270D Anthracene ND 250 ug/Kg 1 09/30/20 WB SW8270D Benz(a)anthracene ND 250 ug/Kg 1 09/30/20 WB SW8270D Benzo(a)pyrene ND 250 ug/Kg 1 09/30/20 WB SW8270D Benzo(b)fluoranthene ND 250 ug/Kg 1 09/30/20 WB SW8270D Benzo(ghi)perylene ND 250 ug/Kg 1 09/30/20 WB SW8270D Benzo(k)fluoranthene ND 250 ug/Kg 1 09/30/20 WB SW8270D Chrysene ND 250 ug/Kg 1 09/30/20 WB SW8270D Dibenz(a,h)a nth racene ND 250 ug/Kg 1 09/30/20 WB SW8270D Fluoranthene ND 250 ug/Kg 1 09/30/20 WB SW8270D Fluorene ND 250 ug/Kg 1 09/30/20 WB SW8270D Indeno(1,2,3-cd)pyrene ND 250 ug/Kg 1 09/30/20 WB SW8270D Naphthalene ND 250 ug/Kg 1 09/30/20 WB SW8270D Phenanthrene ND 250 ug/Kg 1 09/30/20 WB SW8270D Pyrene ND 250 ug/Kg 1 09/30/20 WB SW8270D QA/QC Surrogates %2-Fluorobiphenyl 78 % 1 09/30/20 WB 30-130% %Nitrobenzene-d5 74 % 1 09/30/20 WB 30-130% %Terphenyl-d 14 94 % 1 09/30/20 WB 30-130% RUPQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitation) ND=Not Detected at RUPQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a%)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If you are the client above and have any questions concerning this testing,please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. AOL Phyllis hiller,Laboratory Director October 01,2020 Reviewed and Released by: Rashmi Makol, Project Manager Vert Page 4 of 14 PH0EYIXk,*-. _., �N A C C p9O,yc� U � Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY# 11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Donnie Feenex Innov8tive Environmental Services October 01, 2020 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 09/28/20 13:00 Location Code: INNOVAT Received by: B 09/29/20 16:00 Rush Request: Standard Analyzed by: see"By" below P.O.#: Laboratory Data SDG ID: GCG87166 Phoenix ID: CG87167 Project ID: 506 W WILLIAM ST RYE BROOK NY Client I D: NORTH WALL RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 91 % 09/29/20 CJ SW846-%Solid Soil Extraction for SVOA PAH Completed 09/29/20 K/M SW3546 Volatiles- STARS/CP-51 1,2,4-Trimethylbenzene 12000 83 ug/Kg 50 09/30/20 JLI SW8260C 1,3,5-Trimethylbenzene 92 83 ug/Kg 50 09/30/20 JLI SW8260C Benzene ND 170 ug/Kg 50 09/30/20 JLI SW8260C Ethylbenzene 170 170 ug/Kg 50 09/30/20 JLI SW8260C Isopropylbenzene 500 83 ug/Kg 50 09/30/20 JLI SW8260C m&p-Xylene ND 170 ug/Kg 50 09/30/20 JLI SW8260C Methyl t-Butyl Ether(MTBE) ND 83 ug/Kg 50 09/30/20 JLI SW8260C Naphthalene 9700 83 ug/Kg 50 09/30/20 JLI SW8260C n-Butylbenzene 2900 83 ug/Kg 50 09/30/20 JLI SW8260C n-Propylbenzene 1600 83 ug/Kg 50 09/30/20 JLI SW8260C o-Xylene ND 170 ug/Kg 50 09/30/20 JLI SW8260C p-Isopropyltoluene 2000 83 ug/Kg 50 09/30/20 JLI SW8260C sec-Butylbenzene 2200 83 ug/Kg 50 09/30/20 JLI SW8260C tert-Butylbenzene 91 83 ug/Kg 50 09/30/20 JLI SW8260C Toluene ND 170 ug/Kg 50 09/30/20 JLI SW8260C Total Xylenes ND 170 ug/Kg 50 09/30/20 JLI SW8260C QA/QC Surrogates %1,2-Dichlorobenzene-d4(50x) 101 % 50 09/30/20 JLI 70-130% %Bromofluorobenzene(50x) 107 % 50 09/30/20 JLI 70-130% %Dibromofluoromethane(50x) 86 % 50 09/30/20 JLI 70-130% %Toluene-d8(50x) 96 % 50 09/30/20 JLI 70-130% Sem ivolati les-STARS/C P-51 Acenaphthene 1900 250 ug/Kg 1 09/30/20 AW SW8270D Ver 1 Page 5 of 14 Project ID: 506 W WILLIAM ST RYE BROOK NY Phoenix I.D.: CG87167 Client ID: NORTH WALL RL/ Parameter Result PQL Units Dilution Date/Time By Acenaphthylene ND 250 ug/Kg 1 09/30/20 AW SW8270D Anthracene 750 250 ug/Kg 1 09/30/20 AW SW8270D Benz(a)anthracene ND 250 ug/Kg 1 09/30/20 AW SW8270D Benzo(a)pyrene ND 250 ug/Kg 1 09/30/20 AW SW8270D Benzo(b)fluoranthene ND 250 ug/Kg 1 09/30/20 AW SW8270D Benzo(ghi)perylene ND 250 ug/Kg 1 09/30/20 AW SW8270D Benzo(k)fluoranthene ND 250 ug/Kg 1 09/30/20 AW SW8270D Chrysene ND 250 ug/Kg 1 09/30/20 AW SW8270D Dibenz(a,h)anthracene ND 250 ug/Kg 1 09/30/20 AW SW8270D Fluoranthene ND 250 ug/Kg 1 09/30/20 AW SW8270D Fluorene 5300 250 ug/Kg 1 09/30/20 AW SW8270D Indeno(1,2,3-cd)pyrene ND 250 ug/Kg 1 09/30/20 AW SW8270D Naphthalene 10000 2500 ug/Kg 10 09/30/20 AW SW8270D Phenanthrene 12000 2500 ug/Kg 10 09/30/20 AW SW8270D Pyrene 2000 250 ug/Kg 1 09/30/20 AW SW8270D QA/QC Surrogates %2-Fluorobiphenyl 71 % 1 09/30/20 AW 30-130% %Nitrobenzene-d5 91 % 1 09/30/20 AW 30-130% %Terphenyl-d14 96 % 1 09/30/20 AW 30-130% •2-Fluorobiphenyl(10x) Diluted Out % 10 09/30/20 AW 30-130% •Nitrobenzene-d5(10x) Diluted Out % 10 09/30/20 AW 30-130% •Terphenyl-d14(10x) Diluted Out % 10 09/30/20 AW 30-130% RUPQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitation) ND=Not Detected at RUPQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a%)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: Volatile Comment: Elevated reporting limits for volatiles due to the presence of target and/or non-target compounds. All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If you are the client above and have any questions concerning this testing,please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. Phyllis hiller,Laboratory Director October 01, 2020 Reviewed and Released by: Rashmi Makol,Project Manager Ver 1 Page 6 of 14 PHOEUX �N A C C p9O�y�E 4- Environmental Laboratories, Inc. a 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY# 11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Donnie Feenex Innov8tive Environmental Services October 01, 2020 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 09/28/20 13:00 Location Code: INNOVAT Received by: B 09/29/20 16:00 Rush Request: Standard Analyzed by: see"By"below P.Q.#: Laboratory Data SDG ID: GCG87166 Phoenix ID: CG87168 Project ID: 506 W WILLIAM ST RYE BROOK NY Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Datefrime By Reference Percent Solid 90 % 09/29/20 CJ SW846-%Solid Soil Extraction for SVOA PAH Completed 09/29/20 K/M SW3546 Volatiles-STARS/CP-51 1,2,4-Trimethylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C 1,3,5-Trimethylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C Benzene ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C Ethylbenzene ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C Isopropylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C m&p-Xylene ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C Methyl t-Butyl Ether(MTBE) ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C Naphthalene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C n-Butylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C n-Propylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C o-Xylene ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C p-Isopropyltoluene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C sec-Butylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C tert-Butylbenzene ND 1.0 ug/Kg 1 09/30/20 JLI SW8260C Toluene ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C Total Xylenes ND 2.1 ug/Kg 1 09/30/20 JLI SW8260C QA/QC Surrogates % 1,2-Dichlorobenzene-d4 100 % 1 09/30/20 JLI 70-130% %Bromofluorobenzene 96 % 1 09/30/20 Al 70-130% •Dibromofluoromethane 100 % 1 09/30/20 JLI 70-130% •Toluene-d8 99 % 1 09/30/20 JLI 70-130% Sem iolatiles-STARS/CP-51 Acenaphthene ND 260 ug/Kg 1 09/30/20 WB SW8270D Ver 1 Page 7 o/14 Project ID: 506 W WILLIAM ST RYE BROOK NY Phoenix I.D.: CG87168 Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Date/Time By Acenaphthylene ND 260 ug/Kg 1 09/30/20 WB SW8270D Anthracene ND 260 ug/Kg 1 09/30/20 WB SW8270D Benz(a)anthracene ND 260 ug/Kg 1 09/30/20 WB SW8270D Benzo(a)pyrene ND 260 ug/Kg 1 09/30/20 WB SW8270D Benzo(b)fluoranthene ND 260 ug/Kg 1 09/30/20 WB SW8270D Benzo(ghi)perylene ND 260 ug/Kg 1 09/30/20 WB SW8270D Benzo(k)fluoranthene ND 260 ug/Kg 1 09/30/20 WB SW8270D Chrysene ND 260 ug/Kg 1 09/30/20 WB SW8270D Dibenz(a,h)anthracene ND 260 ug/Kg 1 09/30/20 WB SW8270D Fluoranthene ND 260 ug/Kg 1 09/30/20 WB SW8270D Fluorene ND 260 ug/Kg 1 09/30/20 WB SW8270D Indeno(1,2,3-cd)pyrene ND 260 ug/Kg 1 09/30/20 WB SW8270D Naphthalene ND 260 ug/Kg 1 09/30/20 WB SW8270D Phenanthrene ND 260 ug/Kg 1 09/30/20 WB SW8270D Pyrene ND 260 ug/Kg 1 09/30/20 WB SW8270D QA/QC Surrogates •2-Fluorobiphenyl 75 % 1 09/30/20 WB 30-130% • Nitrobenzene-d5 75 % 1 09/30/20 WB 30-130% %Terphenyl-d 14 94 % 1 09/30/20 WB 30- 130% RUPQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitation) ND=Not Detected at RUPQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a %)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If you are the client above and have any questions concerning this testing,please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. Phyllis hiller, Laboratory Director October01, 2020 Reviewed and Released by: Rashmi Makol, Project Manager Vert Page 8 o/14 7L 10 6 96ed OE Oct-0L 0"0 66 66 TO 66 66 % L6 8p-auanpl% 0E Oct-OL £'9 Z6 86 V L 96 76 % 68 9ue4l9waonOowojq!O% 0£ OEt-OL TO L6 L6 TO L6 L6 % 96 auezuegaon!;owwg% m Oct-OL 0'L 66 86 TO 86 86 % 86 qp-auazuagojolgo!p-Z'L era OE Oct OL 0'0 L6 L6 £,7 L6 96 0'9 ON aianlol OE 06L OL O'L 66 86 L'Z £6 96 0,9 ON auazuaglAing-ual OS Oct-OL 0,0 SOL SOL 0'£ 66 ZOL 0,9 ON auezueglAing-oas OE OSt-OL 0,L ZOL COL L'E 96 66 0,9 ON auen!ollAdadosl-d of Oct-OL 0'L 66 OOL Z,7 76 86 0'9 ON auajAy-o 0E OEt-OL 0'L 86 66 VZ 76 96 0'9 ON auezuaglAdoid-u OE Oct-OL 0'Z LOL Cot L'7 96 66 0'9 ON auezuaglAing-u 0£ M-OL £'7 7L L 6 L L 0'E 66 ZOL 0'9 ON euale414deN OE Ost-OL L'9 L LL L6 8'7 98 Z8 0'9 ON (391W)J0419 IAlnq-1 IL4l9VY OE OEL-OL 0'L 66 OOL Z'£ £6 96 O,S ON auaft-dgw OS Oct-OL 0'L 86 66 ZT Z6 96 0,9 ON auazuagjAdojdosi 0£ Oct-OL 0,l 86 66 17*9 L6 L6 O"S ON auazueglA413 OS Oct-OL TO £6 £6 9'7 L8 L6 O'S ON auazuag OE Oct-OL 0,L 86 66 L'Z £6 96 0'9 ON 9uazu9glA4lawul-S'E'L OE Oct-OL 0'Z L6 66 Z'Z Z6 76 O'S ON auazuaglA4l9wul-7'Z'L Iana-1 4 !H HOS- s91ileIon (NOS)L9 LL8J0) L869890:ON aldweS DC)'(6m/6n)HZOLL7S 4o1e9 0DM0 OE 0£L-OE Z'E 96 Z6 0'Z 66 LOL % 86 7lp-IAua4dj9l% OS Oct-cc £'OL Z8 7L 87L £8 £L % £8 SP-auazuagal!N% OE Oct-of £'L 9L SL TZ L8 6L % L8 IAu94d!gojonl3-Z% 06 Oct-OS 817 98 L8 L'7 78 88 0£Z ON auejAd of 07L 07 Z'L 78 £8 Z'Z Z6 06 0£Z ON augJglueuagd O£ OK 07 Z'£ Z9 79 8'L L9 Z9 0£Z ON auale414deN os 014 Ob 0-0 98 98 L'Z £6 96 OEZ ON 9u9jAd(po-E'Z'L)ouepu! oc 071-017 9"7 68 98 TO 76 76 OEZ ON auejonld O£ On-07 0-0 78 78 7'£ L8 06 0£Z ON aua4luejon1d 0E 07t-07 V L 68 06 0'L L6 86 0£Z ON 9u9oej4lue(4'e)zu9q!O 0£ On-07 L-L 06 68 Z'Z 06 Z6 0£Z ON auesti40 of 014-07 Z-6 Z9 89 L'L £L 89 0£Z ON 9ua4luejonO(M)ozu9g o£ 07L-07 Z-L L8 08 L'L 88 68 O£Z ON 9ua!tiad(!46)ozu9g OE 07t-07 8'£ COL LOL £'£ £ZL Ell 0£Z ON auagluejonO(q)ozuag of o7t o7 Z'Z £6 L6 0'E L6 OOL 0£Z ON au9jAd(e)ozu9g O£ 07t o7 L'Z 96 76 0'Z 86 OOL 0£Z ON auaoejglue(e)zueg 0£ OK 07 Z'L 78 £8 £'Z 98 88 0£Z ON aua0ej4lud OS OK-07 97 8L 9L 0'0 78 78 0£Z ON 9u9lA414deuaoy of O£t-OE S'Z Z8 08 £'Z 88 98 0£Z ON 9u94lgdeu9oy HOS - OH oilewojy Jeelonu lod (89LL890'L9LL8J0'99LL890)Z6£L8JD:0N aldweS Z)D '(ft6n)L6£L79 Ple9 00/V0 sl!w!i si!wll Oda % % Oda % % -18 jUel9 J919weJed Odc oea SIN Osw SW Sol OSol Sol MIG pro Rio 99LL8000 O'I JdS elea DOND OZOZ `LO jagoioo £Z80-S79(098)xed ZOL L-S79(098)'lal LO£L L #AN 9709O 10'Jalsa4oueW'OL£xo9FO'd'aM!dwnl alpp!yq lse3 L89 _ oul `saijoleaoge-1 JeJuauauainu3 a W- o6,,00y N �� QA/QC Data SDG I.D.: GCG87166 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % 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%,25-160%for Chloroethane-HL and Trichlorofluoromethane-HL. QA/QC Batch 547515(ug/kg), QC Sample No:CG87209(CG87166,CG87168) Volatiles -Soil (Low Level) 1,2,4-Trimethylbenzene ND 1.0 99 105 5.9 98 94 4.2 7o-13o 3o 1,3,5-Trimethylbenzene ND 1.0 101 107 5.8 102 98 4.0 70-130 30 Benzene ND 1.0 102 105 2.9 99 96 3.1 7o-13o 3o Ethylbenzene ND 1.0 102 105 2.9 98 93 5.2 7o-130 30 Isopropylbenzene ND 1.0 105 108 2.8 111 105 5.6 7o-13o 3o m&p-Xylene ND 2.0 100 103 3.0 97 90 7.5 70-130 30 Methyl t-butyl ether(MTBE) ND 1.0 104 103 1.0 98 98 0.0 70-130 30 Naphthalene ND 5.0 109 113 3.6 67 59 12.7 70-130 30 m n-Butylbenzene ND 1.0 100 106 5.8 92 87 5.6 70-130 30 n-Propylbenzene ND 1.0 103 110 6.6 105 102 2.9 7o-130 3o o-Xylene ND 2.0 101 106 4.8 98 93 5.2 70-130 30 p-Isopropyltoluene ND 1.0 102 109 6.6 98 94 4.2 70-130 30 sec-Butylbenzene ND 1.0 109 116 6.2 111 107 3.7 70-130 30 tert-Butylbenzene ND 1.0 104 109 4.7 107 103 3.8 7o-13o 3o Toluene ND 1.0 102 108 5.7 96 93 3.2 7o-13o 3o %1,2-dichlorobenzene-d4 101 % 102 100 2.0 98 100 2.0 70-130 30 %Bromofluorobenzene 96 % 100 100 0.0 97 94 3.1 70-130 30 %Dibromofluoromethane 100 % 103 104 1.0 99 106 6.8 7o-13o 3o %Toluene-d8 99 % 100 101 1.0 100 99 1.0 70-130 30 Comment: Additional 8260 criteria: 10%of LCS/LCSD compounds can be outside of acceptance criteria as long as recovery is 40-160%,25-160%for Chloroethane-HL and Trichlorofluoro methane-H L. m=This parameter is outside laboratory MS/MSD specified recovery limits. 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 Phyllis hiller, Laboratory Director MS Dup-Matrix Spike Duplicate NC -No Criteria Octob r 01,2020 Intf-Interference Page 10 of 14 0 N N N � > Q- C: C D NON Q m'0y) C L U Q E m L) c N x m. m U N J U yo � � U N c N m :3 E E o 4'o c o N v cm o p N O T O m N a O N c I rr � c ^N m c W � N _ ~ m 0 Q v c Q 2 16 z nE z A o V - = c x co r g W 00 00 �L U' c X .i U Y V x o N G) t a i.i c N N E c U C c V/ co T C U 0 U .0 p m y a— � mE w E U O N o a '1-7 c o cc a CL c 0 CMI x C a Ev E to a m o 0 o o �,o c N N N L O N '- N U O U L U tll O In NN y M N M U N O N O Q c0 N z z Q o N O a '�= f0 N YO J N c Cc d m O 0 x O O a O c In U E z ovw m o 1L- aEn :� C �t4 ACCogoq PHOENIX - c� Environmental Laboratories Inc. ne �7 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY # 11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Comments October 01, 2020 SDG I.D.: GCG87166 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: None. Page 12 o/14 \N A C C p 9O�y PHOEIVIX*-� U � Environmental Laboratories, Inc. Q NY# 11301 587 East Middle Turnpike,P.O.Box 370,Manchester,C7'06045 Tel.(860)645-1102 Fax(860)645-0823 NY Temperature Narration October 01,2020 SDG I.D.: GCG87166 The samples in this delivery group were received at 2.8°C. (Note acceptance criteria for relevant matrices is above freezing up to VQ Page 13 of 14 ,l S 3 SE ❑ g v G1 i ee E v a oLL CCU //JJ U d y C 3 a `�l ��� /SOS, 01•y LL 0 a L a a a o x O V d ls, Ji JA y)o a N N iJy� ��°s2lOs�ti aI ❑ ❑ ❑ ❑ ❑ n c hr C m m aEi �o _O � V o2ti ?ff � n U (°o y � Q o� 07 O ,ig m �n ca0i�v a000O0 L ° °bm E v .d ia U i Eu� cvOi>�MMU Ura) ❑ El w ❑❑ ZI❑El❑ El ❑ 0 B. �Ao ° m a S d U c m O ❑ I CD m c m m 0 o n ` O ors z E E $U m N U U co O a W o zi❑ ❑ El ❑ El cn g Q U cD � � •N y �' (7 y j m Z CD O c x Q O Q L w r O ll m N N] ULL' z z � r t0 F❑❑❑ ❑❑ `n Z Ll U o E 00 < L.L. c m °i y a 61 U X w = n= a 0 0 j w t N > V y d d c O c N w z Z O Q o ' Q� .- El El El El CLtf w W E m F Z ODm tn _L3 U) Q my A x m m a _ L Y u ° m a � 0 x U 33 o f a w a c� c O 3 «' ❑ El 11 El v o (D r^ '(A ro � E Ng V1�— � 1 _ ° ° c 0 rn a o 3co 1 a ( V o a v N v m 1 CL E o ?v / o a_ N �1 E U 3 m t4 3 (D Cr O V vw� m(in) m Y v U a O _ o O cO m cmm V) C 9._ m y L U c 3 �a r in m xOtrO x w JO C` o C U Q n n J E m �3— o m ^ E ruin �0w0 = o a U NEW YORK Department of STATE OF APR - 9 2Q24 OPPORTUNITY Environmental Conservation VILLAGE OF RYE BROOK Spill Incidents Database Search Details BUILDING DEPARTMENT Spill Record Administrative Information DEC Region: 3 Spill Number: 2002859 Spill Date/Time Spill Date: 07/14/2020 Spill Time: 11-34:00 AM Call Received Date: 07/14/2020 Call Received Time: 11:34:00 AM Location Spill Name: HERRERA UST Address: 506 WEST WILLIAM ST City: RYE BROOK County: Westchester Spill Description Material Spilled Amount Spilled Resource Affected #2 fuel oil UNKNOWN Soil Cause: Equipment Failure Source: Private Dwelling Waterbody: Record Close Date Spill Closed: 11/16/2020 "Date Spill Closed" means the date the spill case was closed by the case manager in the Department of Environmental Conservation (the Department). The spill case was closed because either; a) the records and data submitted indicate that the necessary cleanup and removal actions have been completed and no further remedial activities are necessary, or b) the case was closed for administrative reasons (e.g., multiple reports of a single spill consolidated into a single spill number). The Department however reserves the right to require additional remedial work in relation to the spill, if in the future it determines that further action is necessary. If you have questions about this reported incident, please contact the Regional Office where the incident occurred. 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Sn:,;.�;.w -:: �.air •l S,:.@•+%-'-'`':� ,1:r 1�ti ,rr•55�r•t. :�5,2t! .ti ,tad'}5ti•,:, ;7?«I:i:..: ,,;•. ;�•_' fir. .,.� ..�.. ,.., •<� ti4t . ,.a. .�.'�4.. r•5••; 5 r•5 - i�. -.�.J<v'�-,.iy .:•:�c;:Y�y.4% ::��:t/,_\::-t;"_s/�-_4r•.,�.� 'd, ,.r/• 7 t.,.cai�:�. :. --�+- ^2.�. �e-'t�C"t;:?:.r -a +a+e=;.::r'1;;.�'u C' (t��b�� r:.+. ,=` 7 s.r�-�y +y j4y`r R ,•, Z `r¢�'� - rr�3` :.Y� ° 1 � :�Lt- ,�7 :1•t ttV i A5} '; \,((�"T�'S(.`�,i�� a.�lK`>r-^ •� �':N !-�'•' �'-W�n' emu' �` ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-� 03/13/2020 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 CONTNAMEACT Allan Twitty _ The Allan Twitty Insurance Agency,LLC PHONE 6537AI o.Extr (845)278-6160 FAX Nor (845)278 P.O.Box 419 E-MAIL i ll aan atWtt insuranCe.com ADDRESS: @ Y INSURERS AFFORDING COVERAGE NAIC f1 Patterson NY 12563 INSURERA: Westchester Surplus Lines Insurance Company INSURED INSURERS: Liberty Mutual Insurance Co Envirostar Innovation Corp INSURERC: 50 Fields Lane INSURER D: INSURER E: Brewster NY 10509 INSURER F: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DDlYYYY LIMITS �',X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 RENTED CLAIMS-MADE X OCCUR PREMI E A AG ToEa occurrence) $ 50,000 X Professional Liability MED EXP(Any one person) $ 10,000 A X Pollution Liability G46854408 003 12/29/2019 12/29/2020 PERSONAL 8 ADV INJURY $ 1,000,000 GGGEEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY EC 1N I LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: Professional/Pollution I s $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B 'X OWNED AUTOS ONLY AUT OS SCHEDULED BAS 58 50 04 14 01/04/2020 01/04/2021 1 BODILY INJURY(Per accident) $ X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Per accident) $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE S i EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ g WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 'OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S Inland Marine Scheduled Equip $250,748 B BMO 58 48 44 33 01/01/2020 01/01/2021 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance 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. Building Dept. AUTHORIZED REPRESENTATIVE 938 King Street Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YoItK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Envirostar Innovation Corp (845)279-9555 Attn:Gregory DiNapoli 1c.NYS Unemployment Insurance Employer Registration Number of 50 Fields Ln Brewster,NY 10509 Insured Work Location of Insured(Only required d coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 82-3325897 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a" Building Dept. 4 938 King Street 6-755123-02-03 Rye Brook,NY 10573 3c.Policy effective period 06/29/2019 to 06/29/2020 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"3"insures the business referenced above in box 1 a"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? EYES 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 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: Dominica R.Twitty (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ��� �Q % y 06/28/2019 (Signature) (Date) Title: Member Telephone Number of authorized representative or licensed agent of insurance carrier: (845)278-6160 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) wwvd.wcb.ny.gov Tara Gerardi From: Mike Izzo Sent: Wednesday,June 24, 2020 11:30 AM To: Tara Gerardi Subject: FW: Message from Dig Safely New York, Inc. (DSNY) From: sadasupport@ufpo.org Sent: Wednesday, June 24, 2020 11:29:48 AM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 06/24/2020 11:28 To: VIL RYE BROOK PRIMARY Transmitted: 06/24/2020 11:29 00006 Ticket: 06240-545-073-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 506 To: Name: W WILLIAM ST Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT RIGHT SIDE OF PROPERTY AS FACING NearSt: S RIDGE ST AND LYON ST Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: UNDERGROUND OIL TANK REMOVAL Duration: 1 DAYS Depth of excavation: 15 FEET Site dimensions: Length 15 FEET Width 15 FEET Start Date and Time: 07/01/2020 07:00 Must Start By: 07/16/2020 ------------------------------------------------------------------------------ Contact Name: ROBIN DINAPOLI Company: ENVIROSTAR CORP Addrl: 50 FIELDS LN Addr2: City: BREWSTER State: NY Zip: 10509 Phone: 845-279-9555 Fax: 845-279-0196 Email: INFO@TANKREMOVALSERVICES.COM Field Contact: ROBIN Alt Phone: 845-279-9555 Working for: HERRERA ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members:ALTICE USA CONED SUEZ WTR WESTCHESTER BELL-VALHALLA/WSCHSTR VIL RYE BROOK WESTCHESTER CTY SWR WESTCHESTER JOINT WTR z