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HomeMy WebLinkAboutMP22-161 DR t4�V JJ V V 9 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 ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 3,2023 Kyong Woo Lee&Jung Ok Chung 19 Bayberry Lane Rye Brook,New York 10573 Re: 19 Bayberry Lane, Rye Brook,New York 10573 Parcel ID#: 129.84-2-8 As per the Certification letter from Innov8tive Environmental Services Inc. dated February 15, 2023, the removal of an underground oil tank and installation of a new underground oil tank under Mechanical Permit #22-161 issued on 11/1/2022 has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building& Fire Inspector /to QyE DRC�v�. ,,/�' 19b2•��O 7 BUILDING DEPARTMENT �}�JILDING 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 - - - - - - - - - - -- - - - - Ilpipc IO REPO - - - - - - - - - - - - - - - - - - - - ADDRESS :— _ y DATE: �1 U 3 PERMIT �+ 1 V\' \� \ # ISSUED:�SECT: \V� BLOCK: LOT: LOCATION: UA Q- 00 � `dtUPA CY: 1 U ❑ 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 F �, '� ��C_ V eI ❑ L.P. GAS '� s ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION [[-'FINAL Z❑ OTHER QyE BRC�� O� Zm I-A •T�O� '982 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: PERMIT# ( ISSUED: SECT: BLOCK: LOT: LOCATION: �1 C C X ` ` 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 , S , lrz ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING l c') �C,(� _ l_ ,e 1 \ e �` C^V ❑�ROSS CONNECTION SL Q - FINAL OTHER QyEBR*J32i, 0 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 - - - - - - - - - - - - - - -- - - - - &1ADDRESS: n Qra� DATE: ��'�- .A LC. n 'Y PERMIT# `. `I` y �JI ISSUED: I``SECT: Z LBLOCK: LOT: LOCATION: ` `� �'� < </ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑; REJECTED/REINSPECTION ❑ SITE INSPECTION �\ n� REQUIRED ❑ FOOTING ` V\ ❑ 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 m W u a 064 ck � Ei 4 1 7 0.4 [W I�■,I C j G1 �i M O t �. o °A a W o wa Ia � A z O y c zooms 5 v Q W O w ° �,� .8 �v H o z z � � „ a �i �' z � HS � �, •y � �r �I a°O Pl a" Vols � BUIL MENT OCT 18 2022 VIL � .� J .� OOK 938 KING NY 10573 VILLAGE OF RYE BROOK (914)9 39-5801 BUILDING DEPARTMENT o r Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: mlb,=-) Approval Date., NOv k2022 Permit Fee:$s3 /0 Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded,Licensed Contractor. 2. Your contractor's valid proof of liability insurance.(Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tank. 5.Dig Safely New York#(dial 811): 10142-001-391 6, Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations. Indicate Permit Tvne: Installation •Removal�Abant( )/ • Buried in Ground i}(1 1. Address: 19 Bayberry Lane SBL: 129.84-2-8 Zone: 2. Property Owner&Address: Lee Kyong Woo 19 Bayberry Lane, Rye Brook Phone#: 914-417-1626 Cell#: email: kwlee49er@hotmall.com 3. Contractor&Address: Innov8tive Environmental Services 392 Columbus Ave Valhalla, NY 10595 Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com 4. Applicant: Innov8tive Environmental Services Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com 5. Indicate Fuel Type:Fuel Oil -L.P.Gas( )-Gasoline( )•Other( ): 6. Number and Capacity of each Tank: Removal of(1) 300 Gal UST and Installation of(1) 300 Gal UST in same location 7. Exact Location(s)of each Tank: Removal of UST from the rear of the property and installation at same location, 6/U2020 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Donald Feeney ,being duty sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Contractor for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn.to before me this Sworn t before me this day o ,20� .___—ARY.of ,20 7-7 ignature roperty Owner Signature of Ap icant Lee Kyong Woo Donald Feeney APt Name of Pr$perty O r ` t Name of Applic t _.� NORI Notary PtlNib StM9 of ew orkNotary Public,State of New York 1ME613Lic.No.01ME6130833Qualified in Westchester Coun estchester uCommission Ex Tres July 25,20pires July 25. must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property,and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 b/l/2020 I Y \� ;< c Z I O m co(J/ N cu L O I I � I Q .7 V L 0 ^ - O 1 O, 0 00® i I "t >O (� CD c --- V' ------- --------------- � v 1 � c c I I � Q\ l i c v I v i � N I � P c N N � E c c a) N O > Gl > Q V1 w O 00 o = > uLA m O N L c > d 3 � I 7� I SH10001looNcount on our products. trust in our people. 3 , J storage tanks "`" Avg 414-1 'highguar • underground HT-1 089 PRODUCT DETAILS The HighGuard Tank features a strong This superior strength coating resists HighGuard Features dielectric coating of high solids surface damage due to impact or abrasion » UL-58 and UL-1746 compliant polyurethane for protection,even under that may occur during transportation, » Provides 75 mils dielectric the most difficult conditions.The rigging and installation. polyurethane protection HighGuard protective coating is a dense, » Cured films are free of pores solvent-free,tar-free,two-component HighGuard tanks do not require cathodic » Must pass a 15,000 volt spark test polyurethane coating system with high protection or expensive corrosion before shipment impact properties and tensile strength. monitoring.They out-perform fiberglass- » Strong,flexible and resistant to impact, reinforced polyester clad tanks and do not abrasion and corrosion After manufacturing and rigorous require any artificial reinforcement. » No cathodic protection testing,the tank's exterior surfaces are monitoring required commercially blasted with steel grit in The finished tank is quality checked by a » Highland standard 10-year preparation for coating. spark test to ensure coating integrity and limited warranty effective corrosion protection that can be HighGuard's spray-applied coating ensures measured in decades,rather than years. » Highland 30 year limited warranty is available an even thickness of 75 mils over the entire surface of the tank. 814.893.5701 1 highlandtank.com highguard tank g guide HT-1 089 Volume Tank Dimensions Tank-Top Sump Manway Extension Flanged Isolation Spool Gallons Diameter Length Double-wall Full Coupling Flanged Fitting Interstitial Half Coupling Manway Monitoring Pipe 240 3'2" 4'-0" NPTFtting Liking Lugs 300 T-2" 5-0" 500 4'-0„ 51-51. 1,000 4'-0" 10'-9" Ladder Polyester Hold-Down Strap 1,000 S. 6-0" i 1,500 5'4" 9'-0" 2,000 5'-4" 12'-0" Z500 5'-4" 15-0" Length(Inside) 3,000 5'A" 18'-0" 4,000 5'-4" 24'-0" HighGuard Protected Steel 4,000 6'-0" 19'4" Outerrank 4,000 8'-0" 10'-8" Steel 5,000 6'-0" 2T-10" Inner Interior UL-Listed Steel Tank Tank Primary Tank 51000 8'-0" 13'-0" L ning 10.ga.to.375" thik steel 6,000 6'-0" 28'-8" A 75 mil(min) / coating is 6,000 8'-0" 16'-0" applied to the steel grit-blasted 8,000 10'-0" 14'-0" tank surface 8,000 8'4" 21'-4" 10,000 10'-0" 17-0" Diameter(inside) 10,000 8'-0" 26'-8" 12,000 10'-0" 20'-6" 12,000 8'-0" 32'-0" Product Compatible Flexible Designs » Alternate fuel compatible without the » Volumes from 240-50,000 gallons 15,000 10'-0" 25'-6" additional cost of internal linings » Custom sizes 15,000 8'-0" 401-0" » Safe storage for all motor fuels and » Multi-product storage compartments 20,000 to'-0" 34'4. biofuels,including biodiesel and 20,000 10'-6" 31'-0" ethanol blends Environmentally Friendly 25,000 10'-0" 42'-6" » Most environmentally-friendly coating Cost Effective on the market 25,000 10'-6" 38'-9" » On a total installed-cost basis, » Uses no hazardous materials 30,000 10'4. 51'-2" HighGuard's cost is less than any other in production 30,000 10'-6" 46'-6" unmonitored tank configuration on » Can be disposed of as a non-hazardous 40,000 12'-0" 47-6" the market today material-steel tanks are 100% 50,000 12'-0" 59'-6" » No job site spark or air test required recyclable » Lightweight construction for lower shipping and handling costs M H101008 anheim,PA Greensboro,NC Friedens,PA Mancelona,MI4535 Elizabethtown Road 2700 Patterson Street 1510 Stoystown Road 9517 Lake StreetManheim,PA 17545-9410 Greensboro,NC 27407-2317 Friedens,PA 15541-7402 Mancelona,MI 49659-7968an 717.664.0600 336.218.0801 814.443.6800 231.687.8412 Stoystown,PA Watervliet,NY Lebanon,PA Clarkston,Ml One Highland Road 958 19th Street 2225 Chestnut Street 4701 White Lake Road Stoystown,PA 15563-0338 Waterliet,NY 12189-1752 Lebanon,PA 17042-2504 Clarkston,MI 48346-2554 814.893.6701 618.273.0801 717.664.0602 248.625.8700 PROWLYAll INAMF.RICA 0 Highland Tank-HT-1089-012019 CleanEarth"le Manifest# 2569590 I GLOBAL JOB NUMBER: 3 FACILITY APPROVAL NUMBER: Please Check One: i ❑Clean Earth of Carteret ❑Clean Earth of Maryland ❑Clean Earth of New Castle F] Clean Earth of Greater Washington 24 Middlesex 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 L]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 Philadelphia,PA 19153 Kearny,NJ 07032 Morrisville,PA 19067 Ph:215-724-5520 Ph:973-344-4004 Ph.215-428-1700 Non-Hazardous Material Manifest TEPNER�r e Print Clearly) ATOR'S NAME&SITE ADDRESS: GROSS WEIGHT: �t0�1C ❑Tons ❑Yards TARE WEIGHT: Uk []Tons ]Yards GENERATOR'S PHONE: NET WEIGHT: ❑Tuns Yards DESCRIPTION OF MATERIAWSAMPLE ID AND LOCATION GENERATOR'S CERTIFICATION - 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: Signature: Date and Time: TRANSPORTER Company: Phone Number: Address: Truck#and License Plate: Driver: SW Haulers Permit#: I Type or Print Clearly) (applicable state permit#) I hereby certify that the above named material was picked up at the site listed above. Driver Signature: Date and Time: DESTINATION I hereby certify that the above named material was delivered without incident to the facility noted above. Driver Signature: _ Date and Time: I hereby certify that the above named material has been accepted at the above referenced facility. Authorized Signature: Date and Time: TRANSPORTER WSW 1/5/22 ITEM+CE WM500/PRO'S C14010E PRINTING,INC.1d08801-1515 p CC INWIE MAR - 2 2023 N N OVt�� ■ VILLAGE OF RYE BROOK 3UILDING DEPARTMENT ENVIRONMENTAL SERVICES INC . W February 15, 2023 New York State Department of Environmental Conservation Spill Prevention and Response 0ohn.odee@dec.ny.gov RE: Kyong Woo Lee 19 Bayberry Lane Rye Brook, NY Spill#2207285 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. On November 29, 2022 IES removed (1) 300 Gal Underground Storage Tank (UST) from the back yard. The 300 Gal UST was used to store #2 fuel oil. The tank was cut and cleaned in accordance to New York State Department of Environmental Conservation (NYSDEC) Regulations 613.9 (B). During the removal activities, IES found holes in the UST. The holes allowed fuel oil into the subsurface, thereby impacting the ground underneath the tank. On January 16, 2023 IES began the remediation process by excavation ex-situ reclamation of impacted soil. The soil remediation performed by IES generated 12.76 tons of fuel oil contaminated soils. Petroleum contaminated soils removed during the remedial action were properly disposed of at Clean Earth of Carteret, New Jersey located at 24 Middlesex Avenue, Carteret, NJ 07008. A copy of the weight ticket is included for your records. Following the remedial action, IES collected samples from the four side walls, labeled 4 Wall Composite and 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 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914) 449-6608 Email: service@innov8enviro.com 4 1 NNOV,�8TIVE ENVIRONMENTAL SERVICES INC . 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. The tank grave was then backfilled with 3 yards of screened backfill and another 300 Gal UST was installed in the same location as the removal. 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 10523. A scrap ticket is attached for your viewing. IES, on behalf of Mr. Lee, requests closure of the New York State DEC spill case number 2207285. 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, Mr. Lee, and the Village of Rye Brook Building Department. 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, t-- Donald Feeney Project Manager Innov8tive Environmental Services Inc. 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914) 449-6608 Email: service@innov8enviro.com 3/2/23,12:28 PM Spill Incidents Database Search NEW YORK Department of STATF.OF OPPORTUNITY Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 2207285 Spill Date/Time Spill Date: 11/29/2022 Spill Time: 12:00:00 PM Call Received Date: 11/29/2022 Call Received Time: 12:01:00 PM Location Spill Name: LEE - UST Address: 19 BAYBERRY LANE City: RYE BROOK County: Westchester Spill Description Material Spilled Amount Spilled Resource Affected #2 fuel oil UNKNOWN Unknown Cause: Equipment Failure Source: Private Dwelling Waterbody: Record Close Date Spill Closed: 03/01/2023 "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. Refine This Search https://www.dec.ny.gov/cfmx/extapps/derexternal/spills/details.cfm?pageid=2 1/1 CleanEafth-* Manifest# 2569590 GLOBAL JOB NUMBER: FACILITY APPROVAL NUMBER: Please Check One: _�_tlean Earth of Carteret� El Clean Earth of Maryland ❑Clean Earth of New Castle ❑Clean Earth of Greater Washington 4 Middlesex 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 ❑Clean Earth of Philadelphia ❑Clean Earth of North Jersey ❑Clean Earth of Southeast Pennsylvania ❑Other 3201 S.61st Street 115 Jacobus Avenue 7 Steel Road East Philadelphia,PA 19163 Kearny,NJ 07032 Morrisville,PA 19067 Ph:215-724-5520 Ph:973-344-4004 Ph:215-428-1700 Non-Hazardous Material Manifest (TVDe or Print Clearly) GENERATOR'S NAME&SITE ADDRESS: GROSS WEIGHT: W06 LteInTons ❑Yards TARE WEIGHT: Tons []Yards GENERATOR'S PHONE: NET WEIGHT: Tons []Yards DESCRIPTION OF MATERIAL/SAMPLE ID AND LOCATION GENERATOR'S CERTIFICATION -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: Signature: Date and Time: TRANSPORTER Company: Phone Number: Address: Truck#and License Plate: Driver: SW Haulers Permit#: (Type or Print Clearly) (applicable state permit#) I hereby certify that the above named material was picked up at the site listed above. Driver Signature: Date and Time: DESTINATION I hereby certify that the above named material was delivered without incident to the facility noted above. Driver Signature: Date and Time: I hereby certify that the above named material has been accepted at the above referenced facility. Authorized Signature: Date and Time: TRANSPCFTER r/Sin rrm*cE■rwo t Pnn c=a Pm. rc.r_aEaem-mm NON-HAZARDOUS WASTE MANIFEST Please print of type (Form designed for use on efite(12 pitch)typewriter) Manifest NON-HAZARDOUS 1.Generator's US EPA ID No. Document No. 521 2 Ppe WASTE MANIFEST t 3.Generator's Name and Mailing Address 4.Ganerata's Phone 5.Transporter i Company Name 6. US EPA ID Number A.State Transportefs ID InnovStive Environmental Services iN Y R 0 0 0 2 3 9 2 1 0 B.Transporter 1 Phone 914-44 9-6 6 0 8 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transponer's ID D.Transporter 2 Phone 9.Designated Facility Name and Ste Address 10. US EPA ID Number E.State Facility's ID F.Facility's Phone 11.WASTE DESCRIPTION 12. Containers 13. 14- Total Unit No. Type Quantity Wt.Nol. a. Non RCRA, Non DOT liquid (Oily Water) 1 T T Gallon G b. E N E R c. A T O W R d. H N QG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes listed Above U) O 0 �4 15.Special Handling Instructions and Additional Information 2 Approval — O Z MAMA FAVAM WAWA 16.OENERATOR'E CERTIFICATION:I hereby carnty that the contents of this shipment are fully and accurately described and are in all respects In proper condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations. Date Printed(Typed Name Signature Month Day Poor T 17.Transporter 1 AcknaMedgement of Receipt of Materials Date R q S Pmtedrryped Name Signature Month Day Year N PO 18.Transporter 2 Acknowledgement of Receipt of Materiels Date __7 T Printedlryped Name Signature Month Day Year E R F 19.Discrepancy Indication Space A C 1 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. L Date T PrintedrTyped Name Signature Month Day Year Y NON-HAZARDOUS WASTE MANIFEST Please print or type (Form designed for use on elite(12 pitch)typewriter) NON-HAZARDOUS 1.Generator's US EPA ID No. Mandest WASTE MANIFEST Document No. 5 4 4 2 �. t 3 Generator's Name and Mailing Address 4.Generator's Phone 5.Transporter 1 Company Name 6. US EPA 10 Number A.State Transportees ID InnovStive Environmental Services N Y R 0 0 0 2 3 9 2 1 0 B.Transporter 1 Phone 914-44 9-6 6 0 9 7 Transporter 2 Company Name 6. JS EPA ID Nt,mber C.State Trensporter's ID D.Transporter 2 Phone 9 Designated Facility Name and Site Address 10, US EPA ID Number E.State Facility's ID F.Facility's Phone 11.WASTE DESCRIPTION 12. Containers 13. 14. Total Unit No. Type Quantity Wt I'Vol. a N on RCRA, Non DOT liquid (Oily Wager) 1 T T Gallon G b. E N E R c. A T O W R d H N 3 G Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above O ic�yy {rL 15.Special Handling Instructions and Additional Information Z' Approval O z 16.GENERATOR'S CERTIFICATION:I herety certify that the contents of this shipment are fully and accurately described and are in all respects in proper condition for transport.The materials described on this manlesl are not subject to federal hazardous waste regulations Date PrintedirTyped Name Signature Month Day Year T 17.Transporter 1 Acknowledgement of Receipt of Materials R Date A Printed/Typed Name Signature N g D y PO 18.Transporter 2 Acknowledgement of Receipt of Materials I Date R Printed7Typed Name SignatureE Month Day Year R F 19.Discrepancy Indication Space A C 1 20.Faciity Owner or Operator,Certification of receipt of the waste materials covered by this manifest.except as noted in item 19. L 1 IDate T Prin ypeo Name Signature Y —_ Monti Day Year i PAYMENT RECEIPT Brookfield Resource Management 100 Lamont Street Elmsford, NY 10523 914-592 5250 vi -. Receipt:1779506 Date:1/16/2023 Customer.69802 Time:3 54.28 PM INNOVATIVE ENVIRONMENTAL 392 COLUMBUS AVE VALHALLA, NY 10595 ID Number: Ticket:1825782 Weigh In:1/16/2023 3 4521 PIA Operaw:Diane D Weigh Out.1/16/21123 3 54 26 PIJ Commodity Gross Tare Net Price TOTAL$ Tanks 12.460 12.100 360 2.2300/CW 8.03 Ticket Total: 8.03 No.of Tickets:l EZCash Paid: S3 00 Payment Method:E'Cash Round Arid: (S003) Total Paid: $8. Foi current pricing,hours and coniect information check US out on the web @lx ookfieldac rap.con r Join Brookfield Scrap on Facebook @webuyacr ap —eliallj:)spaaax3 llnsaa euall»spaa:x3 18 papala0 llnsa8 Z'Z Z'Z> T'T T'I> 09Z 8N/8n L-OZ-O£ET saualAX lelol Z'Z Z'Z> T T T'T> OOL 8N/8n E-88-801 auanlol i'T T'T> 75'O 7S'0> 006S 8N/8n 9-90-86 auazuaq!Alnq-ljal T'T T'T> 75'0 7S'0> OOOTT 8N/8n 8-86-SET auazuaglAing-)as VT I > 75 0 7S'0> OOOOT 8N/8n 9-LS-66 auanlollAdadosl-d Z'Z Z'Z> T'T T'T> 8N/8n 9-L7-S6 aualAX-o I'T T'T> 7S'0 75'O> OOOZT 8N/8n E-OZ-T6 auale414deN T'T T'T> 75'0 7S'0> 006E 8N/8n T-S9-EOT auazuaglAdad-u T'l T'T> 7S'O Vs> OOOZT 8N/8n B-TS-70T auazuaglAing-u T'T T'T> 7S'O 75'0> OE6 8N/8n 7-70-7E9T (381W)Ja413lAing-1IA43aIN Z'Z Z'Z> T'I T'T> 8N/8n T-EZ-T096LT aualAX-dgw T'T T'T> 7S'0 75'O> OOEZ BN/8n B-ZS-86 auazuaglAdadosl Z'Z Z'Z> TJ T'T> OOOT 8N/8n 7-T7-001 auazuaglA413 Z'Z Z'Z> T'T T'T> 09 8N/8n Z-E7-TL auazuag T'T VT> 75'0 7S'0> 0078 2N/8n 8-L9-80T auazuaglAgjawljl-S'E'T I T T'T> 75'0 7S'0> 009E 8N/8n 9-E9-56 aua2uaglA4lawljl-7'Z'T 709ZBMS-IS-dJ/Sl1V.LS—IlleloA OSZ OSZ> OLZ OLZ> OOOOOT 8N/8n 0-OO-6ZT auajAd OSZ OSZ> OLZ OLZ> OOOOOT 8N/8n 8-10-SS auaJ41ueua4d OSZ OSZ> OLZ OLZ> OOOZT 8N/8n E-OZ-16 auale414deN OSZ OR> OLZ OLZ> 005 8N/8n 5-6E-E61 auaiAd(p:)-E'Z'T)ouapul OSZ OSZ> OLZ OLZ> 0000£ 8N/8n L-EL-98 auajonlj OSZ OSZ> OLZ OLZ> OOOOOT BN/Bn 0-77-90Z aua4luejonlj OSZ OSZ> OLZ OLZ> OEE 8N/8n E-OL-ES aua:)ej4lue(4'e)zuaq!0 OSZ OSZ> OLZ OLZ> OOOT 8N/8n 6-TO-STZ auasV40 OSZ OSZ> OLZ OLZ> 008 8N/8n 6-80-LOZ aua43uejonll(j)ozuag OSZ OSZ> OLZ OLZ> 000001 8N/Sn Z-7Z-T6T aualAiad(!48)ozuag OSZ OSZ> OLZ OLZ> OOOT 8N/8n Z-66-SOZ auagluejonlj(q)ozuag OSZ OSz> OLZ OLZ> OOOT 8N/8n 8-ZE-OS auaiAd(e)ozuag OSZ OSZ> OLZ OLZ> OOOT 8N/8n E-SS-95 aua)ej43ue(e)zuag OSZ OSZ> OLZ OLZ> OOOOOT 8N/8n L-ZT-OZT aua:iejgluV OSZ OSZ> OLZ OLZ> OOOOOT 8N/8n 8-96-80Z aualA4l4deuaDV OSZ OSZ> OLZ OLZ> OOOoz BN/8n 6-ZE-EB aua414deua3V OOLZ8MS-TS-d3/SN V.LS-SallleloAl W aS T6 58 % 0IIOS-LDd-XNHd P!IoS lua»ad s:)!ueSjoul/snoauepa3s!A lb llnsa8 l8 llnsa8 I!O Ian j/seg-!!oS IS-dJ sl!u0 SV:) NOO88 3A8 NI AU838AV8 6T.Palwd AN 98ZSZNJ9 'E)OS ilos 11O5 x!JleA dA07llVM 7 A011O8 PI lua!ID zOTI-579(098) £ZOZ/LT/TO EZOZ/LT/TO ale0 uo!l:)alloJ 070901-D'jalsapuelN LBZSZNJ 98ZSZND pi aldweS qel OLE xog O d alidwnl alpp!A Ise]L8S ':)ul 'sauo;ejogel jejuawuaiAu3 xlu@Ogd PHOENIX��',--'35!1,�4 Environmental Laboratories. Inc. Monday, January 23, 2023 Attn: Donnie Feeney Innov8tive Environmental Services 392 Columbus Ave Valhalla NY 10595 Project ID: 19 BAYBERRY LN RYE BROOK SDG ID: GCN25286 Sample ID#s: CN25286 - CN25287 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 VT Lab Registration #VT11301 NH Lab Registration #213693-A,B 587 East Middle Turnpike,P.O.Box 370, Manchester,CT 06040 Telephone(860)645-1102 Fax(860)645-0823 Page 1 o113 �C N ACCO'q WX PHOE f r Environmental Laboratories, Inc. ` NY# 11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 SDG Comments January 23, 2023 SDG I.D.: GCN25286 CN25287-The client prepared low level vial had too much soil. Phoenix prepared sample per method 5035. Page 2 of 13 � �C NN ACC0? iw PH0EVX0 ,A�---' ���` y� U U Environmental Laboratories, Inc. < NY# 11301 1 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference January 23, 2023 SDG I.D.: GCN25286 Project ID: 19 BAYBERRY LN RYE BROOK Client Id Lab Id Matrix BOTTOM CN25286 SOIL 4 WALL COMP CN25287 SOIL Page 3 o/13 PHOEATIX o �NACCpgo�� c� Environmental Laboratories, Inc. a s. 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 Feeney Innov8tive Environmental Services January 23, 2023 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 01/17/23 10:30 Location Code: INNOVAT Received by: CP 01/18/23 16:11 Rush Request: Standard Analyzed by: see "By" below P.O.#. Laboratory Data SDG ID: GCN25286 Phoenix ID: CN25286 Project ID: 19 BAYBERRY LN RYE BROOK Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 85 % 01/18/23 AL SW846-%Solid Soil Extraction for SVOA PAH Completed 01/18/23 R/F SW3546 Volatiles- STARS/CP-51 1,2,4-Tri methyl benzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C 1,3,5-Tri methyl benzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C Benzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Ethylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Isopropylbenzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C m&p-Xylene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Methyl t-Butyl Ether(MTBE) ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C Naphthalene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C n-Butylbenzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C n-Propylbenzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C o-Xylene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C p-Isopropyltoluene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C sec-Butylbenzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C tert-Butylbenzene ND 0.54 ug/Kg 1 01/19/23 JLI SW8260C Toluene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Total Xylenes ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C QA/QC Surrogates % 1,2-Dichlorobenzene-d4 100 % 1 01/19/23 JLI 70-130% % Bromofluorobenzene 92 % 1 01/19/23 JLI 70-130% • Dibromofluoromethane 100 % 1 01/19/23 JLI 70-130% •Toluene-d8 97 % 1 01/19/23 JLI 70-130% Vert Page 4 of 13 Project ID: 19 BAYBERRY LN RYE BROOK Phoenix I.D.: CN25286 Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Date/Time By Reference Semivolatiles-STARS/CP-51 Acenaphthene ND 270 ug/Kg 1 01/19/23 WB SW8270D Acenaphthylene ND 270 ug/Kg 1 01/19/23 WB SW8270D Anthracene ND 270 ug/Kg 1 01/19/23 WB SW8270D Benz(a)anthracene ND 270 ug/Kg 1 01/19/23 WB SW8270D Benzo(a)pyrene ND 270 ug/Kg 1 01/19/23 WB SW8270D Benzo(b)fluoranthene ND 270 ug/Kg 1 01/19/23 WB SW8270D Benzo(ghi)perylene ND 270 ug/Kg 1 01/19/23 WB SW8270D Benzo(k)fluoranthene ND 270 ug/Kg 1 01/19/23 WB SW8270D Chrysene ND 270 ug/Kg 1 01/19/23 WB SW8270D Dibenz(a,h)anthracene ND 270 ug/Kg 1 01/19/23 WB SW8270D Fluoranthene ND 270 ug/Kg 1 01/19/23 WB SW8270D Fluorene ND 270 ug/Kg 1 01/19/23 WB SW8270D Indeno(1,2,3-cd)pyrene ND 270 ug/Kg 1 01/19/23 WB SW8270D Naphthalene ND 270 ug/Kg 1 01/19/23 WB SW8270D Phenanthrene ND 270 ug/Kg 1 01/19/23 WB SW8270D Pyrene ND 270 ug/Kg 1 01/19/23 WB SW8270D QA/QC Surrogates •2-Fluorobiphenyl 83 % 1 01/19/23 WB 30-130% •Nitrobenzene-d5 70 % 1 01/19/23 WB 30-130% •Terphenyl-d14 75 % 1 01/19/23 WB 30-130% RL/PQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitation) ND=Not Detected at RL/PQL 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 January 23, 2023 Reviewed and Released by:Anil Makol, Project Manager Ver 1 Page 5 of 13 PHOEVIXi,_51- �N ACCOq�1yc 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 Feeney Innov8tive Environmental Services January 23, 2023 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 01/17/23 10:30 Location Code: INNOVAT Received by: CID 01/18/23 16:11 Rush Request: Standard Analyzed by: see "By" below P.O.#: Laboratory Data SDG ID: GCN25286 Phoenix ID: CN25287 Project ID: 19 BAYBERRY LN RYE BROOK Client ID: 4 WALL COMP RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 91 % 01/18/23 AL SW846-%Solid Soil Extraction for SVOA PAH Completed 01/18/23 R/F SW3546 Volatiles- STARS/CP-51 1,2,4-Trimethylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C 1,3,5-Trimethylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Benzene ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C Ethylbenzene ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C Isopropylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C m&p-Xylene ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C Methyl t-Butyl Ether(MTBE) ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Naphthalene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C n-Butylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C n-Propylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C o-Xylene ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C p-Isopropyltoluene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C sec-Butyl benzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C tert-Butylbenzene ND 1.1 ug/Kg 1 01/19/23 JLI SW8260C Toluene ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C Total Xylenes ND 2.2 ug/Kg 1 01/19/23 JLI SW8260C QA/QC Surrogates % 1,2-Dichlorobenzene-d4 96 % 1 01/19/23 JLI 70-130% %Bromofluorobenzene 96 % 1 01/19/23 JLI 70-130% %Dibromofluoromethane 96 % 1 01/19/23 JLI 70-130% %Toluene-d8 94 % 1 01/19/23 JLI 70-130% Ver 1 Page 6 of 13 Project ID: 19 BAYBERRY LN RYE BROOK Phoenix I.D.: CN25287 Client ID: 4 WALL COMP RL/ Parameter Result PQL Units Dilution Date/Time By Reference Semivolatiles-STARSXP-51 Acenaphthene ND 250 ug/Kg 1 01/19/23 WB SW8270D Acenaphthylene ND 250 ug/Kg 1 01/19/23 WB SW8270D Anthracene ND 250 ug/Kg 1 01/19/23 WB SW8270D Benz(a)anthracene ND 250 ug/Kg 1 01/19/23 WB SW8270D Benzo(a)pyrene ND 250 ug/Kg 1 01/19/23 WB SW8270D Benzo(b)fluoranthene ND 250 ug/Kg 1 01/19/23 WB SW8270D Benzo(ghi)perylene ND 250 ug/Kg 1 01/19/23 WB SW8270D Benzo(k)fluoranthene ND 250 ug/Kg 1 01/19/23 WB SW8270D Chrysene ND 250 ug/Kg 1 01/19/23 WB SW8270D Dibenz(a,h)anthracene ND 250 ug/Kg 1 01/19/23 WB SW8270D Fluoranthene ND 250 ug/Kg 1 01/19/23 WB SW8270D Fluorene ND 250 ug/Kg 1 01/19/23 WB SW8270D Indeno(1,2,3-cd)pyrene ND 250 ug/Kg 1 01/19/23 WB SW8270D Naphthalene ND 250 ug/Kg 1 01/19/23 WB SW8270D Phenanthrene ND 250 ug/Kg 1 01/19/23 WB SW8270D Pyrene ND 250 ug/Kg 1 01/19/23 WB SW8270D QA/QC Surrogates %2-Fluorobiphenyl 62 % 1 01/19/23 WB 30-130% % Nitrobenzene-d5 53 % 1 01/19/23 WB 30-130% %Terphenyl-d14 56 % 1 01/19/23 WB 30-130% RL/PQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitation) ND=Not Detected at RL/PQL 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. 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QA/QC Batch 660836(ug/kg), QC Sample No: CN25287 (CN25287) Volatiles - Soil (Low Level 1,2,4-Trimethylbenzene ND 1.0 88 94 6.6 87 85 2.3 70-130 30 1,3,5-Trimethylbenzene ND 1.0 89 94 5.5 87 84 3.5 70-130 30 Benzene ND 1.0 89 93 4.4 90 90 0.0 70-130 30 Ethylbenzene ND 1.0 89 94 5.5 88 88 0.0 70-130 30 Isopropylbenzene ND 1.0 89 96 7.6 89 88 1.1 70-130 30 m&p-Xylene ND 2.0 86 91 5.6 87 84 3.5 70-130 30 Methyl t-butyl ether(MTBE) ND 1.0 87 90 3.4 89 86 3.4 70-130 30 Naphthalene ND 5.0 92 98 6.3 86 81 6.0 70-130 30 n-Butylbenzene ND 1.0 91 99 8.4 87 85 2.3 70-130 30 n-Propylbenzene ND 1.0 91 97 6.4 90 88 2.2 70-130 30 o-Xylene ND 2.0 89 93 4.4 88 87 1.1 70-130 30 p-Isopropyltoluene ND 1.0 91 97 6.4 89 86 3.4 70-130 30 sec-Butylbenzene ND 1.0 91 97 6.4 88 85 3.5 70-130 30 tert-Butyl benzene ND 1.0 90 96 6.5 89 86 3.4 70-130 30 Toluene ND 1.0 92 96 4.3 93 92 1.1 70-130 30 • 1,2-dichlorobenzene-d4 97 % 100 104 3.9 101 101 0.0 70-130 30 •Bromofluorobenzene 97 % 98 97 1.0 96 96 0.0 70-130 30 •Dibromofluoromethane 99 % 94 97 3.1 97 94 3.1 70-130 30 •Toluene-d8 96 % 99 100 1.0 101 100 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 Trichlorofluoromethane-HL. 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 hiller, Laboratory Director NC-No Criteria Janua 23, 2023 Intf- Interference Page 9 of 13 0 0 N C, T.0 Q- C C D d O Q Q'y N �L � � T J O O d U Q E N 7 N U c.N N_ N � N U x � x o a) m U N N .J L J U O � O U w C N m 7 �E o _ C U O O N N O N N af O Obi 7 t N O T C m `m /L C N i�� O N 16 U 16 d m C IA c O W N fN V m O C Q '00 C 13 Q 2 f6 Z °-E Z N C K a) W Do °n a)� �� N m coi L Z c U U m x � o C7 m`O •L C.)U U x N A♦ L a Q c N U U c c m o� N c m o m m n c � ° m y n— Y n n m E o E O U _T`O N O N C n C'Fu O QN m X 47 � c c E E 0 0 N ) N a owe .. o C U O c7 N m T N O U U y 04 N N m C N c+�) O d N y O n U � In � } } Q m o Z Z o 0 7 N 7 m N J N C T U7 O 0 x O 0. (n a O C N N c U E Z mp- 0 O m r m`o 2 U a E n C ,N ACCO,O PHOE WX - U � Environmental Laboratories, Inc. NY# 11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Comments January 23, 2023 SDG I.D.: GCN25286 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: None. Page 11 of 13 \N ACCO'? PHOENIX 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 NY Temperature Narration January 23,2023 SDG I.D.: GCN25286 The samples in this delivery group were received at 1.7°C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 12 of 13 LZOUOL n28 UL-13d 1 4� z -•i *r y ! YSi. 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N y o m m W t 9 y a KOWO ac I\ m fi a E� W E w in in 2Occ0 x �o Page 13 of 13 Laura Petersen From: Service Innov8enviro <service@innov8enviro.com> Sent: Wednesday, October 19, 2022 9:49 AM To: Laura Petersen Subject: RE:Tank Application - 19 Bayberry Lane Good morning, Laura. I reached out to the customer. He said he would get the approval over to us. I'll forward it as soon as it comes in. Thank you, Norine From: Laura Petersen<LPetersen@ryebrook.org> Sent:Tuesday, October 18, 2022 11:31 AM To:Service Innov8enviro<service@innov8enviro.com> Subject:Tank Application - 19 Bayberry Lane Good morning, At your earliest convenience please advise if there is the HOA approval letter for the tank removal / install at 19 Bayberry Lane. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ipetersen(d-)ryebrook.or4 1 173'/2 Ivy Hill Crescent Rye Brook, NY 10573 914-939-2440 October 26, 2022 OCT 31 2022 VILLAGE Of BROOK Kyong Woo Lee ; BUILDING DEPARTMr.-NT 19 Bayberry Lane Rye Brook, NY 10573 Re: Oil Tank Replacement Dear Kyong Woo Lee, The Architecture and Grounds Committee (A&G) has reviewed and approved your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Property Manager NE'WYORK Department of STATE Of OPPORTUNITY Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 2207285 Spill Date/Time Spill Date: 11/29/2022 Spill Time: 12:00:00 PM Call Received Date: 11/29/2022 Call Received Time: 12:01:00 PM Location Spill Name: LEE - UST Address: 19 BAYBERRY LANE City: RYE BROOK County: Westchester Spill Description Material Spilled Amount Spilled Resource Affected #2 fuel oil UNKNOWN Unknown Cause: Equipment Failure Source: Private Dwelling Waterbody: Record Close Date Spill Closed: 03/01/2023 "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. Return To Results Refine This Search 0 ` 0 s,-Ab �s a l A. a lei - s $,�Ill 11 1,s'at `yr .' •1 : e CL k GOP-, C_ {Y V Q. N tn CIS 40 LIJ U n C- %;tea o ° �ecti on E° solo `%•3t�` ' zi A. � � :I ,1 W Lij Ono L.Li \: J >_ \ i�l CIO � f ✓' � ,�,�°�_-��: CAS ►+� Z "' „ �:iz :� 00 :c�•I >• Lz7 C V_ .fl � tw \� 3 --- — -- (k% Jy� <�Rr)i► =Tj,� 1js,�i" dy,si Il` ty"11 14� : `mar 11� ;' _' r. . Ill .'�}Ja'pn��1 �\ aie:.: "Amy ''� (( g A DATE(MM/DDIYYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 2/15/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mt Pleasant Capacity NAME: EVita DermanlSPHONE FAX P.O. Box 1689 •914-205-7682 ac No):914-205-7682 Pearl River NY 10965 ADDRESS: Evita.Dermanis@mtpcap.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Century Surety Company 36951 INSURED INNOENVI INSURER B:Pro ressive Casualty Insurance Company 24260 Innov8tive Environmental Services Inc. 392 Columbus Ave INSURERC: Valhalla NY 10595 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:903137522 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 TYPE OF INSURANCE ADDL SU D POLICY NUMBER MM/DD EFF MMIDDY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CCP1039913 2/14/2022 2/14/2023 EACH OCCURRENCE $1.000.000 DAMAGE TO CLAIMS-MADE IX-1OCCUR PREMISES EaE occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY JEa 7 LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ B AUTOMOBILE LIABILITY 016663982 1/15/2022 1/15/2023 COMBINED SINGLE LIMIT $1,000,000 Es accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED 1 . RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability CCP1039913 2/14/2022 2/14/2023 Each Claim 1,000.000 Aggregate 1,000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street UTHORIZED REPRESENTATIVE 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 NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE g. .0 ^^A^^^ 824703808 J� MT PLEASANT CAPACITY AGENCY fi ' 1 BLUE HILL PLAZA STE 1689 ❑r. L. PEARL RIVER NY 10965 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER INNOV8TIVE ENVIRONMENTAL VILLAGE OF RYE BROOK SERVICES INC 938 KING STREET 392 COLUMBUS AVENUE RYE BROOK NY 10573 VALHALLA NY 10595 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2455 047-7 370473 10/02/2022 TO 10/02/2023 10/4/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2455 047-7, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DONALD FEENEY VICE PRESIDENT FRANK MORACO INNOV8TIVE ENVIRONMENTAL SERVICES 20F2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 792990792 U-26.3 Laura Petersen From: Mike Izzo Sent: Thursday, November 17, 2022 3:32 PM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, November 17, 2022 3:31:59 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 11/17/2022 15:30 To: VIL RYE BROOK PRIMARY Transmitted: 11/17/2022 15:31 00004 Ticket: 11172-001-399-00 Type: Regular Previous Ticket: 10142-001-381-00 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 19 To: Name: BAYBERRY LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ENTIRE PROPERTY NearSt: ARBOR DR Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 11/22/2022 Depth of excavation: Site dimensions: Start Date and Time: 11/22/2022 07:00 Must Start By: 12/07/2022 ------------------------------------------------------------------------------ Contact Name: SARAH MASSA Company: INNOV8TIVE ENVIRONMENTAL SERVICES Addrl: 392 COLUMBUS AVE Addr2: City: VALHALLA State: NY Zip: 10595 Phone: 914-449-6608 Fax: Email: service@innov8enviro.com Field Contact: NORINE MEYER i Alt Phone: 914-449-6608 Email: service@innov8enviro.com Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/WSCHSTR CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 2 c Laura Petersen From: Mike Izzo Sent: Friday, October 14, 2022 1:34 PM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, October 14, 2022 1:34:11 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 10/14/2022 13:33 To: VIL RYE BROOK PRIMARY Transmitted: 10/14/2022 13:34 00009 Ticket: 10142-001-381-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 19 To: Name: BAYBERRY LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ENTIRE PROPERTY NearSt: ARBOR DR Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 10/19/2022 Depth of excavation: Site dimensions: Start Date and Time: 10/19/2022 07:00 Must Start By: 11/02/2022 ------------------------------------------------------------------------------ Contact Name: SARAH MASSA Company: INNOV8TIVE ENVIRONMENTAL SERVICES Addrl: 392 COLUMBUS AVE Addr2: City: VALHALLA State: NY Zip: 10595 Phone: 914-449-6608 Fax: Email: service@innov8enviro.com Field Contact: NORINE MEYER i Alt Phone: 914-449-6608 Email: service@innov8enviro.com Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 2