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Home My WebLink AboutMP23-048 DR O`t6�4+ . GLGWuV JJJ .^ G v �L�vI+JJv VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 12,2024 Edward McLaughlin&Jean McLaughlin 24 Westview Avenue Rye Brook,New York 10573 Re: 24 Westview Avenue,Rye Brook,New York 10573 Parcel ID#: 141.35-1-36 As per the Certification letter from Envirostar Innovative Corporation dated June 26,2024,the removal of an underground oil tank under Mechanical Permit #23-048 issued on 4/18/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRC�k, 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ! We s r✓ A ille DATE: `, a z U L PERMIT# M/ 23 yU ISSUED:54/ -Z3 SECT: III- Sy BLOCK: / LOT: LOCATION: f U / 11,4 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 R NC_ C LA-)I t ✓ _ j y Ptk-- Z V Z 1 ❑ L.P. GAS -© FUEL TANK ❑ FIRE SPRINKLER S ju(2- 6L, -r P, e e ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 1 QyE BRC�k• O� - BUILDING DEPARTMENT �UILDING 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 wwwryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - ADDRESS : \A�NN Z") DATE: ✓ I�- O�� PERMIT# `V/ [} O�l ISSUED: SECT: ' 1 BLOCK: LOT: LOCATION: OCCUPANCY: 1y ❑ Violation Noted ) THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION v�/CsYF'y �,' REQUIRED ❑ FOOTING v ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas � FUEL Gas ❑ FIRE SPRINKLER ❑ FINAL PLUMBING c ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Qjryl a , a ■ a ■ O m e d' "O U 00 z a ■ CA ■ W. k+ V a Q = y w O a = W W , 1� M 00 N M.y O � v [11J r , d 1— aI Q 4 O p � �° C/5 i O 0 Q � a O � �. u o F � � 6 9- v w o c ob ■ ■ o OR, C eIIa " a co-0 � '�ovovw � V ■ O r7 � ` � W �j U z ,� ,,� p•, � ° � a h� z a am ■ x �Q == a °° W a �:) z a go � y W r °�' 0-4 ON 00 O o a U � o w w Eo v W cn can W COE4p o `„' Z Sri O ZR o . W v O v o V0 � � N �, C� A Z a cn a" �I z W O A 07, .4 � ° u o b : a �4 w x � � b BUILDkSd MENT VIL E OF RY OOK APR 17 2023 938 KING > r RYE BRO NY 10573 -70668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove Abandon and/or Install Fuel Stora a Tank (*Storage Tanks in excess of 1,100 gallons/requireistration with the County of Westchester) �?: APR 1 � Approval Date: g Permit Fee: 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: S 185.00 pet I anh. 5.Dig Safely New York# (dial S 1 1): 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, #—/7 4 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 Type: Installation O • emoval Y)• Abandonment ( ) /Above Ground O•Buried in Ground 00< 1. Address: 2- iUI Vu Q.V1VJ2 . SBL: / i 35-yl 3& zone: j6)-F 2. Property Owner& Address: 6-(A-UY-Ata �ALt h Phone#AQ- 3 - jq 7 T Cell#: email: 3. Contractor . &r rAdrd�re tX�ss-ms+t�Cin L-:fto �1V►�P4-fv I - Po 99Y �PJD Y)Vtf- � It) S� Phone#: `� � zq 13 2-1 Cell #: 901 1k ITT to�2 email: � Nacobs@ a Cal?Nf6r (ek4 4. Applicant:C Ggic.�n F-vkUyU0VvLJL1 Phone#: Ce11#: 2C11 Ue 1AUi UT1Z-onnail: 5. Indicate Fuel Type: uel ril LP.Gash( )•Gasoline( }•Other 6. Number and Capacity of each'tank: M emWe- -) V S } 7. Exact Location(s)of each Tank: t 8/12/2021 STATE OFF W YVRK�C, ILJNTY OF WESTCHESTER ) as: �8 (� 1 `,,//7 ,being duly sworn,deposes and states that he/she is the applicant above named, (p t Me of ind id al signing as the applicant) and further es t t s)b 'the legal owner of the property to which this application pertains,or that(s)he is the _ MIA l f v 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 to before me this / 3_ day of 20 day of Signature of Property Owner Si re of Applicant V ca>yq Print Name of Property Owner am ofAp ant Notary Public M J. NIGRO ry Public of New Jersey My Commission Expires This application must be properly completed in its entirety and must inclupAp/m3ked signature(s) of the legal owner(s) of the sub iect 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. s 8/12/202I STA-M-()F N w PORK COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above natned. (pent same of iudividuaS 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 for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,attormg,etc-) That all statcments 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 lire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and reaulations. —' -�Swom to before me this 13 Try sworn to before the this day of flp'eie- ,.20 ;2-3 day of 2t> t � - Signawre of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 111is anplication tnust be properly completed in its entirety and intist include the notarized signature(s)of the lepl,owners)of the subject property, and the applicant of rcwrd in the spaces provided. Any application not properly completed in iu entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. DOMPAGE GAYA VITHANAGE Notary Public-State of New York NO.01V16424207 Qualifed in Westchester County My Commission Expires Oct 25, 2025 8/IM'W1 CC� � O�FH APR 17 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT New tail Tanis Location 32 ft I -J Basement 960 Sq ft lift ILI IL 32 ft Existing DRIVEWAY 55a-a on UST -ENV1f� O5Tf�f� IN NOVAT I ON C OR POR AT ION The name you trust for environmental needs SO F*Ws lane Phone: 845-279-9SSS Email: info@tankremovalservices.com Brewster.NY 10509 Fax: 94S-279-01% wvnv.tankremovalservices.com June 26.2023 Mr.John O'Dee New York State Department of Environmental Conservation 100 Hillside Avenue. Suite I W n (� (� ��' White Plains.NY 10603 RE: Spill # 2300874 ( AUG - 8 2024 24 Westview Ave. Rve Brook.NY VILLAGE OF RYE BROOK BUILDING DEPARTMENT To Whom It May Concern. On June 6. 7& 8. 2023 Envirostar Innovation Corp. performed Remediation at the property listed above. for a spill called in by others. Envirostar excavated. loaded and disposed of'46 29 tons ofcontaminated soil. Manifests are enclosed for your records and review.Once all soil %%as removed. we took(3)exit samples.(1) from the base.(1) foundation and(I)three wall composite. The sample is enclosed for your records and review. we could no longer dig with the machine next to or under the foundation. We went down approx. 12'. No ground"ater was cneountered. Excavation was then baekfilled and disturbed area restored. The property is on to%%n water and sewer. The tank was disposed of by us. Enclosed please find: I. Soil Sample Results 2. Soil Disposal Manifest 3. Tank Disposal Receipt 4. Diagram Based on the enclosed we respectfully request that this spill file be closed. If you have any questions. please do not hesitate to call 845-279-9555. Thank you. regory DiNapoli Enyirostar Innovation Corp. PHOM AMz!-;2`� iEttcironmental laboratories. Inc. Thursday, June 22, 2023 Attn: Greg DiNapoli EnviroStar Innovation 50 Fields Lane Brewster NY 10509 Project ID: MCLAUHLIN 24 WESTVIEW, RYE SDG ID: GCO23265 Sample ID#s: CO23265 -CO23267 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, ��( + A�L 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 Page 1 of 15 \lac \0 A C C o'g PHOLAM Q f U Environmental Laboratories, Inc. U 587 East Middle Turnpike,RO.Box 370,Manchester,CT 06045 NY#11301 x Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference June 22, 2023 SDG I.D.: GCO23265 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Client Id Lab Id Matrix BASE CO23265 SOIL FOUNDATION CO23266 SOIL 3 WALL COMPOSITE CO23267 SOIL Page 2 of 15 pj) �40 �N Accoq 0 oll, U Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY#11301 Tel.(860)545-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Greg DiNapoli EnviroStar Innovation June 22, 2023 50 Fields Lane Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 06/07/23 Location Code: ENVIROS Received by: MMN 06/08/23 16:50 Rush Request: Standard Analyzed by: see"By"below P.O.* Laboratory Data SDG ID: GCO23265 Phoenix ID: CO23265 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Client ID: BASE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 75 % 06/08/23 CV SW846-%Solid Soil Extraction for SVOA PAH Completed 06/20/23 MO/A SW3546 Volatiles-STARS/CP-51 1,2,4-Trimethylbenzene NO 1.1 ug/Kg 1 06/12/23 JLl SW8260C 1,3,5-Tdmethylbenzene NO 1.1 ug/Kg 1 06/12/23 JLl SW8260C Benzene NO 2.3 ug/Kg 1 06/12/23 JLl SW8260C Ethylbenzene NO 2.3 ug/Kg 1 06/12/23 JLl SW8260C Isopropylbenzene NO 1.1 ug/Kg 1 06/12/23 JLl SW8260C m&p-XAene NO 2.3 ug/Kg 1 06/12/23 JLl SW8260C Methyl t-Butyl Ether(MTBE) NO 1.1 ug/Kg 1 06/12/23 JLl SW8260C Naphthalene 8.5 1.1 ug/Kg 1 06/12/23 JLl SW8260C n-Butylbenzene 6.2 1.1 ug/Kg 1 06/12/23 JLl SW8260C n-PropAbenzene NO 1.1 ug/Kg 1 06/12/23 JLl SW8260C o-Xylene NO 2.3 ug/Kg 1 06/12/23 JLl SW8260C p-Isopropyltoluene 1.8 1.1 ug/Kg 1 06/12/23 JLl SW8260C sec-Butylbenzene 7.9 1.1 ug/Kg 1 06/12/23 JLl SW8260C tert-Butylbenzene NO 1.1 ug/Kg 1 06/12/23 JLI SW8260C Toluene NO 2.3 ug/Kg 1 06/12/23 JLl SW8260C Total Xylenes NO 2.3 ug/Kg 1 06112/23 JLI SW8260C QA/QC Surronates • 1,2-Dichlorobenzene-d4 98 % 1 06/12/23 JLl 70-130% •Bromofluorobenzene 104 % 1 06/12/23 JLl 70-130% •Dibromofluoromethane 87 % 1 06112/23 JLl 70-130% %Toluene-d8 94 % 1 06/12/23 JLl 70-130% Ver 1 Page 3 of 15 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Phoenix I.D.: CO23265 Client ID: BASE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Semivolatiles-STARS/CP-51 Acenaphthene NO 310 ug/Kg 1 06/21/23 AW SW8270D AcenaphthAene NO 310 ug/Kg 1 06/21/23 AW SW82700 Anthracene NO 310 ug/Kg 1 06/21/23 AW SW8270D Senz(a)anthracene 510 310 ug/Kg 1 06/21/23 AW SW8270D Benzo(a)pyrene 550 310 ug/Kg 1 06/21/23 AW SW8270D Benzo(b)fluoranthene 620 310 ug/K9 1 06/21/23 AW SW8270D Benzo(ghi)perylene NO 310 ug/Kg 1 06/21/23 AW SW8270D Benzo(k)fluoranthene NO 310 ug/Kg 1 06/21/23 AW SW8270D Chrysene 480 310 ug/Kg 1 06/21123 AW SW8270D Dibenz(a,h)anthracene NO 310 ug/Kg 1 06/21/23 AW SW8270D Fluoranthene 1200 310 ug/Kg 1 06/21/23 AW SW8270D Fluorene ND 310 ug/Kg 1 06/21/23 AW SW8270D Indeno(1,2,3-cd)pyrene 320 310 ug/Kg 1 06/21/23 AW SW8270D Naphthalene NO 310 ug/Kg 1 06/21/23 AW SW8270D Phenanthrene 1000 310 ug/Kg 1 06/21/23 AW SW8270D Pyrene 1000 310 ug/Kg 1 06/21/23 AW SW8270D QA/QC Surrogates %2-Fluorobiphenyl 69 % 1 06/21/23 AW 30-130% %Nitrobenzene-d5 69 % 1 06/21/23 AW 30-130% %Terphenyl-d14 81 % 1 06/21/23 AW 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. 0 Phyllis hiller, Laboratory Director June 2,2023 Reviewed and Released by: Phyllis Shiller, Laboratory Director Ver 1 Page 4 of 15 PHO ��C ,NACCO'04 ti e � 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: Greg DiNapoli EnviroStar Innovation June 22, 2023 50 Fields Lane Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 06/07/23 Location Code: ENVIROS Received by: MMN 06/08/23 16:50 Rush Request: Standard Analyzed by: see"By"below P.O.#. Laboratory Data SDG ID: GCO23265 Phoenix ID: CO23266 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Client ID: FOUNDATION RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 82 % 06/08/23 CV SW846-%Solid Soil Extraction for SVOA PAH Completed 06/20/23 MO/A SW3546 Volatiles-STARS/CP-51 1,2,4-Trimethylbenzene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C 1,3,5-Trimethylbenzene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C Benzene ND 2.4 ug/Kg 1 06/09/23 JLI SW8260C Ethylbenzene NO 2.4 ug/Kg 1 06/09123 JLI SW8260C Isopropylbenzene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C m&p-Xylene NO 2.4 ug/Kg 1 06/09/23 JLI SW8260C Methyl t-Butyl Ether(MTBE) NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C Naphthalene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C n-Butylbenzene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C n-Propylbenzene NO 1.2 ug/Kg 1 06/09/23 Al SW8260C o-Xylene NO 2.4 ug/Kg 1 06/09/23 JLI SW8260C p-Isopropyltoluene NO 1.2 ug/Kg 1 06/09/23 Al SW8260C sec-Butylbenzene NO 1.2 ug/Kg 1 06/09/23 JLl SW8260C tert-Butylbenzene NO 1.2 ug/Kg 1 06/09/23 JLI SW8260C Toluene NO 2.4 ug/Kg 1 06/09/23 JLI SW8260C Total Xylenes ND 2.4 ug/Kg 1 06/09/23 JLI SW8260C QA/QC Surrolaates • 1.2-Dichlorobenzene-d4 99 % 1 06/09/23 JLI 70-130% •Bromofluorobenzene 98 % 1 06/09/23 JLI 70-130% %Dibromofluoromethane 85 % 1 06/09/23 JLI 70-130% %Toluene-d8 101 % 1 06/09/23 Al 70-130% Ver 1 Page 5 of 15 Project 0: MCLAUHLIN 24 WESTVIEW, RYE Phoenix I.D.: CO23266 Client ID: FOUNDATION R L/ Parameter Result PQL Units Dilution Date/Time By Reference Semivolati les-STARS/C P-51 Acenaphthene ND 280 ug/Kg 1 06/21/23 AW SW8270D Acenaphthylene ND 280 ug/Kg 1 06/21/23 AW SW8270D Anthracene ND 280 ug/Kg 1 06/21/23 AW SW82700 Benz(a)anthracene 310 280 ug/Kg 1 0612l/23 AW SW8270D Benzo(a)pyrene 400 280 ug/Kg 1 06121/23 AW SW8270D Benzo(b)fluoranthene 510 280 ug/Kg 1 06/21/23 AW SW8270D Benzo(ghi)perylene 320 280 ug/Kg 1 06/21/23 AW SW8270D Benzo(k)fluoranthene ND 280 ug/Kg 1 06/21/23 AW SW8270D Chrysene 340 280 ug/Kg 1 06/21/23 AW SW8270D Dibenz(a,h)anthracene ND 280 ug/Kg 1 06/21/23 AW SW8270D Fluoranthene 500 280 ug/Kg 1 06/21/23 AW SW82700 Fluorene ND 280 ug/Kg 1 06/21/23 AW SW8270D Indeno(1,2,3-cd)pyrene 290 280 ug/Kg 1 06/21/23 AW SW8270D Naphthalene ND 280 ug/Kg 1 06/21/23 AW SW8270D Phenanthrene ND 280 ug/Kg 1 06/21/23 AW SW8270D Pyrene 490 280 ug/Kg 1 06/21/23 AW SW8270D QA/QC Surrogates •2-Fluorobiphenyl 65 % 1 06/21/23 AW 30-130% • Nitrobenzene-d5 69 % 1 06/21/23 AW 30-130% %Terphenyl-d14 88 % 1 06/21/23 AW 30-130 RL/PQL=Reporting/Pra cti cal 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, A UL Laboratory Director June 22,2023 Reviewed and Released by: Phyllis Shiller, Laboratory Director Ver 1 Page 6 of 15 PH0E7ff*,-,, Environmental Laboratories, Inc. i 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: Greg DiNapoli EnviroStar Innovation June 22, 2023 50 Fields Lane Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 06/07/23 Location Code: ENVIROS Received by: MMN 06/08/23 16:50 Rush Request: Standard Analyzed by: see"By"below P.O.#: Laboratory Data SDG ID: GCO23265 Phoenix ID: CO23267 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Client ID: 3 WALL COMPOSITE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 70 % 06/08/23 CV SW846-%Solid Soil Extraction for SVOA PAH Completed 06/20/23 MO/A SW3546 Volatiles-STARSICP-51 1,2,4-Trimethylbenzene NO 130 ug/Kg 50 06/12/23 JLl SW8260C 1,3,5-Trimethylbenzene ND 130 ug/Kg 50 06/12/23 JLl SW8260C Benzene ND 4.1 ug/Kg 1 06/09/23 JLl SW8260C Ethylbenzene ND 4.1 ug/Kg 1 06/09/23 JLI SW8260C Isopropylbenzene NO 130 ug/Kg 50 06/12/23 Al SW8260C m&p-Xylene ND 4.1 ug/Kg 1 06/09/23 JLl SW8260C Methyl t-Butyl Ether(MTBE) ND 2.1 ug/Kg 1 06/09/23 JLl SW8260C Naphthalene NO 130 ug/Kg 50 06/12/23 JLl SW8260C n-Butylbenzene ND 130 ug/Kg 50 06/12/23 JLl SW8260C n-Propylbenzene NO 130 ug/Kg 50 06/12/23 JLl SW8260C o-Xylene NO 4.1 ug/Kg 1 06/09/23 JLI SW8260C p-Isopropyltoluene NO 130 ug/Kg 50 06/12/23 JLI SW0260C sec-Butylbenzene NO 130 ug/Kg 50 06/12/23 JLl SW8260C tert-Butyl benzene NO 130 ug/Kg 50 06/12/23 JLl SW8260C Toluene NO 4.1 ug/Kg 1 06/09/23 JLl SW8260C Total Xylenes ND 4.1 ug/Kg 1 06/09/23 JLl SW8260C QA/QC Surrogates • 1,2-Dichlorobenzene-d4 97 % 1 06/09/23 Al 70-130% •Bromofluorobenzene 78 % 1 06/09/23 JLI 70-130% •Dibromofluoromethane 93 % 1 05/09/23 JLl 70-130% •Toluene-d8 95 % 1 06/09/23 JLl 70-130% •1,2-Dichiorobenzene-d4(50x) 99 % 50 06/12/23 Al 70-130% •Bromofluorobenzene(50x) 100 % 50 06/12/23 Al 70-130% Ver 1 Page 7 of 15 Project ID: MCLAUHLIN 24 WESTVIEW, RYE Phoenix I.D.: CO23267 Client ID: 3 WALL COMPOSITE RU Parameter Result PQL Units Dilution Date/Time By Reference %Dibromofluoromethane(50x) 90 % 50 06/12/23 JLI 70-130 %Toluene-d8(50x) 105 % 50 06/12/23 JLI 70-130 Semivolatiles-STARS/CP-51 Acenaphthene ND 330 ug/Kg 1 06/21/23 AW SW8270D Acenaphthylene ND 330 ug/Kg 1 06/21/23 AW SW8270D Anthracene ND 330 ug/Kg 1 06/21/23 AW SW8270D Benz(a)anthracene ND 330 ug/Kg 1 06/21/23 AW SW8270D Benzo(a)pyrene 420 330 ug/Kg 1 06/21/23 AW SW8270D Benzo(b)fluoranthene 600 330 ug/Kg 1 06/21/23 AW SW82700 Benzo(ghi)perylene 370 330 ug/Kg 1 06/21/23 AW SW82700 Benzo(k)fluoranthene ND 330 ug/Kg 1 06/21/23 AW SW8270D Chrysene 390 330 ug/Kg 1 06/21/23 AW SW8270D Dibenz(a,h)anthracene ND 330 ug/Kg 1 06/21/23 AW SW8270D Fluoranthene 580 330 ug/Kg 1 06/21/23 AW SW8270D Fluorene ND 330 ug/Kg 1 06/21/23 AW SW8270D Indeno(1,2,3-cd)pyrene 340 330 ug/Kg 1 06/21/23 AW SW8270D Naphthalene ND 330 ug/Kg 1 0621/23 AW SW8270D Phenanthrene ND 330 ug/Kg 1 06/21/23 AW SW8270D Pyrene 550 330 ug/Kg 1 0621/23 AW SW8270D QA/QC Surrogates •2-Fluorobiphenyl 63 % 1 06/21/23 AW 30-130% •Nitrobenzene-d5 77 % 1 0621/23 AW 30-130% %Terphenyl-d14 80 % 1 0621/23 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(proceeded with a%)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: Volatile Comment: There was a suppression of the last internal standard in the low level analysis,all affected compounds are reported from the methanol preserved high level analysis which did not exhibit this interference. 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 June 2,2023 Reviewed and Released by:Phyllis Shiller,Laboratory Director VW 1 Page 8 of 15 �10 kN ACCO.90 PHOE U � Environmental Laboratories, Inc. _ 587 East Middle Turnpike,P.O.Box 370, Manchester,CT 06045 NY#11301 QA/QC Report Tel.(860)645-1102 June 22, 2023 QA/QC Data SDG I.D.: GCO23265 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPO % % RPD Limits Limits QA/QC Batch 683180(ug/kg),QC Sample No:CO23035(CO23265,CO23266,CO23267) Polynuclear Aromatic HC- Soil Acenephthene NO 230 64 65 1.6 57 69 19.0 30-130 30 Acenaphthylene NO 230 63 70 10.5 55 66 18.2 40-140 30 Anthracene NO 230 71 69 2.9 60 76 23.5 40-140 30 Benz(a)anthracene NO 230 69 61 12.3 58 72 21.5 40-140 30 Benzo(a)pyrene NO 230 73 65 11.6 61 77 23.2 40-140 30 Benzo(b)fluoranthene NO 230 66 61 7.9 57 71 21.9 40-140 30 Senzo(ghi)perylene NO 230 70 60 15.4 59 73 21.2 40-140 30 Benzo(k)fluoranthene NO 230 63 58 8.3 51 68 28.6 40-140 30 Chrysene NO 230 71 69 2.9 60 75 22.2 40-140 30 Dibenz(a,h)anthracene NO 230 71 55 25.4 60 74 20.9 40-140 30 Fluoranthene ND 230 77 92 17.8 65 82 23.1 40-140 30 Fluorene NO 230 68 71 4.3 59 73 21.2 40-140 30 Indeno(1,2,3-cd)pyrene NO 230 71 56 23.6 59 73 21.2 40-140 30 Naphthalene NO 230 55 62 12.0 57 66 14.6 40-140 30 Phenanthrene NO 230 70 69 1.4 59 75 23.9 40-140 30 Pyrene NO 230 77 100 26.0 66 84 24.0 30-130 30 %2-Fluorobiphenyl 72 % 60 57 5.1 54 66 20.0 30.130 30 %Nitrobenzene-d5 73 % 58 119 68.9 57 66 14.6 30-130 30 r %Terphenyl-d14 86 % 71 74 4.1 60 77 24.8 30-130 30 QA/QC Batch 681859(ug/kg),QC Sample No:CO22443(CO23266.CO23267) Volatiles-Soil (Low Level) 1,2,4-Trimethylbenzene NO 1.0 97 102 5.0 70-130 30 1.3,5-Thmethylbenzene NO 1.0 99 104 4.9 70-130 30 Benzene NO 1.0 100 107 6.8 70-130 30 Ethylbenzene NO 1.0 101 106 4.8 70-130 30 Isopropylbenzene NO 1.0 100 105 4.9 70-130 30 m&p-Xylene NO 2.0 99 104 4.9 70-130 30 Methyl t-butyl ether(MTBE) NO 1.0 93 98 5.2 70-130 30 Naphthalene NO 5.0 102 108 5.7 70-130 30 n-Butylbenzene NO 1.0 102 107 4.8 70-130 30 n-Propylbenzene NO 1.0 100 105 4.9 70-130 30 o-Xytene NO 2.0 98 102 4.0 70-130 30 p-isopropyltoluene NO 1.0 99 104 4.9 70-130 30 sec-Butybenzene NO 1.0 101 106 4.8 70-130 30 ten-Butylbenzene NO 1.0 100 104 3.9 70-130 30 Toluene NO 1.0 100 105 4.9 70.130 30 % 1,2-dichlorobenzene-d4 101 % 99 99 0.0 70-130 30 %Bromofluorobenzene 96 % 99 98 1.0 70-130 30 %Dibromofluoromethane 89 % 91 93 2.2 70-130 30 %Toluene-d8 100 % 102 102 0.0 70-130 30 Page 9 of 15 QA/QC Data SDG I.D.: GCO23265 o� o� Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPO % % RPD Limits Limits Comment: The MS/MSD are not reported for this batch. 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 682019(ug/kg),QC Sample No:CO24072(CO23265) Volatiles- Soil (Low Level) 1,2,4-Trimethylbenzene NO 1.0 105 109 3.7 70-130 30 1,3,5-Tdmethybenzene NO 1.0 106 111 4.6 70-130 30 Benzene NO 1.0 101 104 2.9 70.130 30 Ethylbenzene NO 1.0 103 106 2.9 70-130 30 Isopropylbenzene NO 1.0 104 110 5.6 70-130 30 m&p-Xylene NO 2.0 103 106 2.9 70-130 30 Methyl t-butyl ether(MTBE) NO 1.0 98 100 2.0 70-130 30 Naphthalene NO 5.0 103 104 1.0 70-130 30 n-Butylbenzene NO 1.0 112 114 1.8 70-130 30 n-Propylbenzene NO 1.0 105 109 3.7 70-130 30 o-Xylene NO 2.0 101 105 3.9 70-130 30 p-Isopropyttoluene NO 1.0 108 112 3.6 70-130 30 sec-Butylbenzene NO 1.0 106 109 2.8 70-130 30 tert-Butylbenzene NO 1.0 105 109 3.7 70-130 30 Toluene NO 1.0 101 103 2.0 70-130 30 %1,2-dichlorobenzene-d4 99 % 99 99 0.0 70.130 30 %Bromofluorobenzene 97 % 100 100 0.0 70-130 30 %Dibromofluoromethane 88 % 89 88 1.1 70-130 30 %Toluene-d8 96 % 98 96 2.1 70-130 30 Comment: The MS/MSD are not reported for this batch. 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 682045H(ug/kg),QC Sample No:CO24109 50X(CO23267(50X)) Volatiles- Soil (High Level) 1,2,4-Trimethylbenzene NO 250 108 108 0.0 102 107 4.8 70-130 30 1,3,5-Trimethylbenzene NO 250 109 108 0.9 102 108 5.7 70-130 30 Isopropylbenzene NO 250 110 108 1.8 104 109 4.7 70-130 30 Naphthalene NO 250 133 136 2.2 130 132 1.5 70-130 30 LM n-Butylbenzene NO 250 117 116 0.9 109 114 4.5 70-130 30 n-Propylbenzene NO 250 108 108 0.0 102 107 4.8 70-130 30 p-Isopropyttoluene NO 250 114 113 0.9 107 113 5.5 70-130 30 sec-Butylbenzene NO 250 110 110 0.0 104 110 5.6 70-130 30 tert-Butylbenzene NO 250 109 108 0.9 103 109 5.7 70-130 30 %1,2-dichlorobenzene-d4 98 % 99 99 0.0 99 99 0,0 70-130 30 %Bromofluorobenzene 100 % 103 102 1.0 104 103 1.0 70-130 30 %Dibromofluoromethane 92 % 98 98 0.0 97 97 0.0 70-130 30 %Toluene-d8 106 % 100 101 1.0 100 101 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 Tdchlorofluoromethane-HL. I=This parameter is outside laboratory LCS/LCSD specified recovery limits. m=This parameter is outside laboratory MS/MSD specified recovery limits. r=This parameter is outside laboratory RPD specified recovery limits. Page 10 of 15 QA/QC Data SDG I.D.: GCO23265 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits 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 AOL MS-Matrix Spike MS Dup-Matrix Spike Duplicate Phyllis hiller, Laboratory Director NC-No Criteria June 2, 2023 Intf-Interference Page 11 of 15 a N 47 CU 0 L_ r_T J y V y U Q E U= a> � cc U C � A600„ � U x a` T V N N r L.. J U O 0 U N C U rJ � E o- �o 2'o C N N <n � b 4) 0 0) N O 0 m m a O H N C O M C d ca 0 C)C a G 0 O � C � j O > aE d Z o K r a� W 0 N y 6 Cl) a .L O c' X 4) U U ya O t9 L c. _ v U c � C � u � m 19 d m nc � o � y ay O. E o c o a N.E a X oo & o A Q R v x y C C E C w n L 0 t a vow O T O V T N � V N y m V) O C a)cli O N 67 OV _w O-E N C O Q c0 61 r Z Z O D N 7 L N T C J C t0 O O X_ O O ` a O C N U E Z p-C in dEa A C C p,70 PHOEA7X ,-P,%- 0 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 Analysis Comments June 22, 2023 SDG I.D.: GCO23265 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: None. Page 13 o/15 ,N ACCOq PHOEA U Environmental Laboratories, Inc. y NY#11301 Z 587 Fast Middle Turnpike,P.O.Rux 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 NY Temperature Narration June 22,2023 SDG I.D.: GCO23265 The samples in this delivery group were received at 1.8°C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 14 of 15 Abe m � J o Q' o 0 0 �4 N N yry I a3a w w z vL AzzWbL U�l us :yx. ?� s OLu O� f1 d LL olio �I❑LJ❑� ❑N ZOr m �g p + .59 U U m + U c V O. C. eo U c Z Ev c37 m o` ILJ ❑ " d } o 4v .5 m ar co OC �( Ci �9 7 •y U W Oh LL O N m OD r I a� C ^N�r)in 8 a U. m m W I O K Q E c N o .2 o1 so E n v CL Q) > ca s� bps } w w x xl x �i 1 od Z ; 1 ch r� rs � r� O O O I ° 1 j a c to co 0 0x DtsI 0 C) o g q( 9 f s ,p c co r E m U f m 2 y 9 A � J m W to m U c E ; x C rn W U a E M 3 a�' c c V)U) age 15 o GENERATOR 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 llaulers Permit#: (Type or Print Clearly) (applicable state perrnit#) 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: A'. Date and Time: I hereby certify that the above named material has been accepted at the above referenced facility. Authorized Signature: Date and Time: - GENERATOR 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 tree 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 pennit#) 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: GENET AIOR •r GENERATOR 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 tt and License Plate: Driver: SW Ilaulers Permit M (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: f DESTINATION I hereby certify that the above named material was delivered without incident to the facility noted above. Driver Signature: f Date and Time: I hereby certify that the above named material has been accepted at the above referenced facility. Authorized Signature: Date and Time: GEN&A T JR 1. BASS It SON, INC. 9-11 Carleton Avenue Mount Vernon, NY 10550 Phone (914) 667-1442 ♦ Fax (914) 667-9647 Lbassandson(a;aol com CERTIFICATE OF DESTRUCTION Customer: ENVIROSTAR Job Location: 50 FIELDS LANE BREWSTER, NY 10509 Type: #2 UNP STEEL OIL TANK Total Weight: 11,700 LBS. Date: 6/7/2023 DISPOSITION TRANSPORTER COMPANY NAME AND ADDRESS: J. BASS & SON, INC. 9-11 CARLETON AVENUE MOUNT VERNON, NY 10550 I, THE UNDERSIGNED, CERTIFY THAT THE MATERIAL DESCRIBED ABOVE WILL ONLY BE DELIVERED TO A FACILITY FOR DESTRUCTION. SIGNATUR� r ci�� fj.�1� J. Bass & Son, Inc. DATE. 6/7/2023 I, THE UNDERSIGNED, CERTIFY THAT THE MATERIAL WILL BE PROCESSED FOR REMELTING ONLY THIS MATERIAL WILL NOT BE SOLD AS USABLE IN ANY SHAPE, FORM OR MANNER SIGNATURF/J�/;' ro.L J Bass & Son, Inc. DATE: 6/7/2023 6/26123.3 35 PM 24 Westview Ave-Google Maps CO :e 24 Westview Ave too •' ti so a M Imagery(C2023 Airbus,Maxar Technologies,New York GIS,Map data n2023 Google 20 It - M 1 • t 24 Westview Ave o d , 24 Westview Ave, Rye Brook, NY 10573 2828+JR Rye Brook, New York https:llwww.google com/maps,placei24+Westview+Ave.+Rye+Brook.+NY+105731@41.0015357,-73.6830883,84m/data='3m111e314m613m511sOx89c... 1/2 7/5/23,4 11 PM Spill Incidents Database Search NEW YORK Department of STATE OF OPPORTUNITY Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 2300874 Spill Date/Time Spill Date: 05/02/2023 Spill Time: 12:00:00 PM Call Received Date: 05/02/2023 Call Received Time: 12:09:00 PM Location Spill Name: MCLAUGHLIN - UST Address: 24 WESTVIEW AVE 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: 07/03/2023 "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 DATE(MMIDDIYYYY) r4COR0� CERTIFICATE OF LIABILITY INSURANCE �,,...- 04/05I2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CE.-T;FICATE 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 CEF.TIFICATE 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 endorsemeril PRODUCER CONTACT Jane Begreen NAME: Insurance Solutions&Services,Inc. PHONE. Ext: (732)738-6080 n/c No (732)738-6081 619 Amboy Avenue E-MAIL jbegreen@issi-nj.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC III Edison NJ 08837 INSURERA: Great Divide Insurance Company 25224 INSURED INSURERS: Castlton Environmental Contractors LLC INSURER C: 48 Bi-State Plaza INSURER D: INSURER E: Old Tappan NJ 07675 INSURER F COVERAGES CERTIFICATE NUMBER: CL225205033 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MWDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RE T D 300,000 CLAIMS-MADE X 4ff,._;a PREMISES Ea occurrence $ MED EXP(Any one person) $ 20,000 A GLP01549028-20 05/01/2022 05/01/2023 PERSONAL&ADV INJURY $ 1,000,000 GENLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND ErIPLOVERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 jyJ r U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 20(20 i6103) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name&Address of Insured(Use street address only) 11). Business Telephone Number of Insured 845-624-i 312 Castlton Environmental Contractors LLC 48 Bi-State Plaza lc.NYS Unemployment Insurance Employer Old Tappan,NJ 07675 Registration Number of Insured 4700419 ld.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically or Social Security Number limited to certain locations in New York State, i.e., a Wrap-Up 90-0154807 Policy) 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Great Divide Insurance Company Village of Rye Brook 3b.Policy Number of entity listed in box"1 a" 938 King Street WCA1549026 Rye Brook,NY 10573 3c. Policy effective period 5/1/2022 to 5/1/2023 3d. The Proprietor,Partners or Executive Officers are ® included. (Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. 'Ibis certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named or a permit,license or contract issued by a certificate holder,the business mftst 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: Insurance Solutions& Services,Inc. (Print name of authorized representative or licensed agent of insurance carrier) Approved by: � 4/5/2023 (Signature) (Date) Title: Frank G.Jacobs,President Telephone Number of authorized representative or licensed agent of insurance carrier: (732)738-6080 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Tuesday, April 18, 2023 12:23 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/18/2023 12:23 To: VIL RYE BROOK PRIMARY Transmitted: 04/18/2023 12:23 00002 Ticket: 04183-001-753-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 24 To: Name: WESTVIEW AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: CURB TO ENTIRE PROPERTY NearSt: DIXON ST & ROANOKE AVE Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: SOIL REMEDIATION Estimated Work Complete Date: 05/08/2023 Depth of excavation: 25 FEET Site dimensions: Start Date and Time: 04/24/2023 07:00 Must Start By: 05/08/2023 ------------------------------------------------------------------------------ Contact Name: GEORGE PORTA Company: CASTLTON ENVIRONMENTAL CONTRACTORS Addrl: PO BOX 609 Addr2 City: NANUET State: NY Zip: 10954 Phone: 973-207-0931 Fax: Email:jjacobsen@castlton.com Field Contact: GREG SPADACCINI Alt Phone: 973-207-0931 Email:jjacobsen@castlton.com Working for: EDWARD MCLAUGHLIN ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED NYS THWY AUTH / NY SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, May 8, 2023 10:42 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 05/08/2023 10:41 To: VIL RYE BROOK PRIMARY Transmitted: 05/08/2023 10:41 00001 Ticket: 05083-001-069-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 24 To: Name: WESTVIEW AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT LEFT AS FACING NearSt: DIXON ST & ROANOKE AVE Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: SOIL REMEDIATION Estimated Work Complete Date: 05/15/2023 Depth of excavation: 15 FEET Site dimensions: Length 15 FEET Width 15 FEET Start Date and Time: 05/15/2023 07:00 Must Start By: 05/30/2023 ------------------------------------------------------------------------------ Contact Name: ROBIN DINAPOLI Company: ENVIROSTAR CORP Addrl: 50 FIELDS LN Addr2: City: BREWSTER State: NY Zip: 10509 Phone: 845-279-9555 Fax: Email: info@tankremovalservices.com Field Contact: MICHELLE REZZA Alt Phone: 845-279-9555 Email: info@tankremovalservices.com Working for: MCLAUGHLIN ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CON-ED NYS THWY AUTH / NY SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i