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MP23-128
ttoGeY�S'� �t DR �,+GtVy'Y� OT 19 VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 28,2023 The Ciccone 2014 Irrevocable Income Only Trust dated September 29,2014 Theresa Zampaglione,Trustee 1 Edgewood Drive Rye Brook,New York 10573 Re: 1 Edgewood Drive,Rye Brook,New York 10573 Parcel ID#: 135.36-1-30 As per the Certification letter from Innov8tive Environmental Services Inc. dated November 21, 2023, the removal of an underground oil tank and installation of a new above-ground oil tank under Mechanical Permit #23-128 issued on 8/22/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BR(�k• cu � • �9r�2 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— ' �-� �� DATE: PERMIT# y if 3 Ic ISSUED:�o ECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS 0 PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION i REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas `f ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL OTHER BUILDING DEPARTMENT NSPECTOR ❑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:— -Y 4�`� DATE: PERMIT# ISSUED: �� `" ' SECT: BLOCK: LOT: LOCATION: 1 'Q,1 Q `�" �X C�� - 1 \ V V OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ ;.I-- a----FAILED / REI>8PECTION ❑ SITE INSPECTION ,1 ' _ EQUIRED ❑ FOOTING CSZ ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION S 5 1 1 C' ❑ Natural Gas -�6 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING = (� ❑ CROSS CONNECTION l\/r ❑ FINAL � .=C �J��� i A `�j (J ❑ OTHER 1�1 �3 Q . F c�U C-A Qyre_BR(��• O�` tim 198,2. cu � BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - . 1�� ADDRESS: �` `� \ DATE: PERMIT# `v y ISSUED: SECT: BLOCK: LOT: c- �, LOCATION: OCCUPANCY: `— Er Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P.Gas �' �~�v �_Q t �-� . 0, ❑ FUEL TANK / ❑ FIRE SPRINKLER C�) ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER = e s a s e a a s' m ■ rj © N a b � v N ■ � \ N � � � � W a z ° OEM 7ZL x b CA e 00 q� JoCD to o pO FBI s Q W �_ G G] o C _ y A a e O O 0 F O. y W Z o a (n z � o � ela4 � O P-, y W w ( 5 ow ou o �5 awo ° �I W LTOp y � ■ O W H p H a� 0 0 U a cu ■ F-1 '� 0-I , V U zOEM( y a o a s PLO r. � � ■ ON --� A a w W W �Zx � � 7-5 o W ■ oc op �r WAS 10, 5 -d 1:6 V� N v w h cn W Q p p low W A W V x H N ° v > u m ,, m ■ O 0 V O B E � W W O Z z o V,4 � Q■I Q p O U bz owe u Q U U io w a. m > a 0 C7 , A z �, o [�A W � � � d .� � c5, ■ 41414 414 4 4 4 4 4 4 4 4;414 4 4;6 4 4;4 44444a44;4a Qaaaa4;a4;4;a44 BUILD - MENTJ�[ AUG 18 2023 VIL E OF RY OOK 938 KING ET RYE BR ,NY 10573 VILLAGE OF RYE BROOK (914)9 G$. . 9 39-5801 BUILDING DEPARTMENT w V. .o dr 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#: -// Approval Date: AUG 2 2 2023 Permit Fee: S ` 70iF`b 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#C 105.2 or Form# U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment, or Installation: S 185.00 per Tank. 5. Dig Safely New York#(dial 811): 08153-000-100 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, 0811712023 ,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 Tvoe: Installation 64•Removal Abandonment( }/Above Ground 44-•-Buried in Ground (A;�r— 1. Address: 1 Edgewood Drive SBL: 135,36-1-30 zone: 2. Property Owner&Address: Theresa Zampalione Phone#: 914-661-3434 Cell#: email: tzampag@gmail.com 3. Contractor&Address: Innov8tive Environmental Services 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) 550 Gal UST and install (1)275 Gal AST 7. Exact Location(s)of each Tank: Removal of UST from front of property, Installation of AST in crawl space of home 6/1/202a STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Donnie Feeney ,being duly 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 to before me this 1� day of 20 2; day of 20 23 Signature of Property Owner Si ature of Applicant Theresa Zampaglione Donnie Feeney , int Name Qf Pro a Owner P 'nt Name of Applicant vmw %wod � NORIN MEYEA "No" MEYER Notary Public,State of New York ate of New YLic.No.01 ME8130833 E8130ti33Qualltied In Westchester Counchester CounCommiss Ir es Juust be properly completed in its entirety and mnature(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. z 6/1/2020 NE'W PORK Department of Ppa OF Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 2305519 Spill Date/Time Spill Date: 09/27/2023 Spill Time: 12:40:00 PM Call Received Date: 09/27/2023 Call Received Time: 01:00:00 PM Location Spill Name: ZAMPAGLIONE - UST Address: 1 EDGEWOOD DRIVE 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: 12/01/2023 "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 o } � z O -N O O O ,D m ILI � W � GJ O T 2 a) � L � r Q o 0 • o '> � cV O 0 > O c W { v U C H 41 U N N cu � C 41 N O QL N C : O W _ cuEz Z CO O - --- > U m _ O N L C Q1 m E M > Standard n Standard oil tank with strong welded lap joints SAFETY Bottom outlet configuration allows for natural elimination of water build up from condensation DURARIUTY Electrostatic powder-coated paint Made of robust material PEACE OF MIND s 10 years against manufacturing defects(*See warranty certificate for details.) Contractor-friendly.trouble-free installation Product 9 Carcill Model Ga Divirlons" S Weight Ob.) 209101 120 Vertical 12 47"1 23"/30" 170 208101 138 Vertical 12 44"/27"/30" 160 208601 138 Horizontal 12 27"144' 30" 160 207101 220 Stubbies/Vertical 12 44"1 27"/48" 220 203201 G 230 Thin/Vertical grey 12 44'/22'160" 235 203701 G 230 Thin/Horizontal grey 12 22'/44'160' 235 202201 240 Narrow/Vertical 12 47"/23"1b0" 265 202701 240 Narrow/Horizontal 12 23"/47"/60' 265 204201 275 Vertical 12 44'127'/60' 255 204701 275 Horizontal 12 27'144"/60" 255 211201 275 Vertical 10 44'!27'/60" 330 211701 275 Horizontal 10 27'!44'/60" 330 205201 330 Vertical 12 44"127'1 72" 290 205701 330 Horizontal 12 27"/44'172' 290 6 � INNOVt TIVE ENVIRONMENTAL SERVICES INC . November 21, 2023 New York State Department of Environmental Conservation Spill Prevention and Response iohn.odee@dec.ny.sov RE: Theresa Zampaglione 1 Edgewood Drive Rye Brook, NY Spill#2305519 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 September 27,2023 IES removed a 550 gallon Underground Storage Tank (UST)from the property.The 550 gallon UST had been 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 Octobe 17, 2023 IES began the remediation process by excavation ex-situ reclamation of impacted soil. The soil remediation performed by IES generated 34.48 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. Copies of the weight tickets are included for your records. Following the remedial action, IES collected samples from the labeled 3 Wall Composite, W Wall Under House,as well as a bottom sample. The soil samples were collected from areas of the tank grave that exhibited the highest PID readings. The soil samples were collected into laboratory clean glassware, maintained at 4 degrees Celsius, and delivered to Phoenix Environmental Laboratories located in Manchester CT. The soil samples were analyzed by EPA methods 8260 and 8270. Laboratory analysis of the post excavation samples 3 Wall Composite and Bottom showed concentrations of target analysis to be non-detect or below the New York State DEC guidance values (CP -51). The sample labeled W Wall Under House is in 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914)449-6608 Email: service@innov8enviro.com (o 4, *Lr1NNONIVE ENVIRONMENTAL SERVICES INC . exceedance of DEC values. However,further excavation was not possible without disturbing the foundation of the home. Copies of the laboratory analysis are included for your review. The tank grave was then backfilled with 28 yards of screened backfill, brought in from Thalle Industries, Elmsford, NY. Once the tank grave had been backfilled, the UST was removed from the premises and recycled at Brookfield Resource Management, Montrose, NY. A scrap ticket is attached for your viewing. IES, on behalf of Mrs.Zampaglione, requests closure of the New York State DEC spill case number 2305519. 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(permit#MP23-128. This report has been prepared for the use of the New York State DEC, Mrs. Zampaglione,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, Donald Feeney Project Manager Innov8tive Environmental Services Inc. 392 Columbus Avenue, Valhalla, NY 10595 Tel: (914) 449-6608 Email: service@innov8enviro.com N U U N �4 U U ) U � riS U U) co H W M oo Ln O r co - M rI rI 4-j E� O 'n �4 M M rLS O O b� W . 000 R4 z Q) M 4J N N [� CD L() N O —14 O U 'T O N � N o r- � riff �p 3 O \ \ r- M M r-I U) O N 24 I oo ao [- N 3 b) PQ �4 r-i r-i O �4 N O O M : >y U) 1 1 41 co N4JS I U) + U) N H CO �4 a) U O N x o o z h h U N E-i S 4 rl C7 r{ U p U 44 rt w a r-� ro a� � N M O O Ln N �4 r I O a1 O H rI rI N k P4 > b� � `� a�i w U n�, z € m 4-3 w '�_• S4 00 r I N H fCS (� O 4J N o x co 44 < O M O co U 0 N O4 O N > -ri N PU N z H G �-I N W U) >, ' O S4 �4 N N O H C!) —A pG rI N > W f 4 U) r--I rd N O m rt 4I -rl N O rCS �4 U Ll N �4 rl Ca -P �4 U U r� m N U) N (0 E U N U a' 0 > C7 CleanEarth-* Manifest# 2676239 GLOBAL JOB NUMBER: nD7 FACILITY APPROVAL NUMBER: Z3�07 o ZS- Please Check One: lean Earth of Carteret ❑Clean Earth of Maryland ❑Clean Earth of New Castle ElClean Earth of Greater Washirgton 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.61 sl 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: �Sk2b m Z# ns OYards I'M4 TARE WEIGHT: tIC ns ❑Yards GE AERATOR'S PHONE: NE IGHT: Tons ElYards DESCRIPTION OF NIATERIALJSAMPLE ID AND LOCATION GENERATOR'S CERTIFICATION -Incomplete and/or unsigned manifests will cause the load to be delayed and/or rejected. 1 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 cond' r transportation according to all applicable state and federal regulations. Name: Title: Si re: — Date and Time: TRANSPORTER Company:1A10 hr t hone Number. ( q I Address: Truck#and License Plate: 1 Driver: SW Haulers Permit#: (T)Tic or Pnnt Clearly) (applicable state permits) 1 here certify that t above named material was picked up at the site listed above. Driver Signature: / Date and Time:I"/// / �,6 DESTINATION I h"y ccer-tiiffy tha a above na material was delivered without incid t to he faci ity noted above. Driver Signature: j4'L��' 47,K '_/ Date and Time: I hereby rti" t the above named material has been accepted at the aboveenced lity. Authorized Signature: Datc and Timc: FACILITY » m o U ° @ m e ® m U U ° Q © CO ® q ) » m # w m w g c c c n o •§ / / m / / / / & p p p m a a 0 q \ 0 0 / / m m m / / m w a = , o c c / % c 2 m m m m m c e # r e -0 . e w a a 2 w o a ® o Q . . . § m c o 2 ¥ a -00 o / J m m § § ) \ w m m m m@ * b m ) w » a s c g o 9 I @ m @ @ w I 2 m / / /rn / / a m 4 c » CO @ / w * / \ § e w = m w o 0 o m •H I a O o m o w p w e w -H -a 2 w -H t u / 0 \ / w | L ! e | 4 ! w w / o m ( 0 0 @ ; w / / / CD x \ \ \ (0 \ w m a o a@ t ( k 4 c » m N o a } CO / \ / 00 / ! �CO /m 0 \ § ) o m ( / & ) 2 / \ § -0 o \ 2 f CD / / / a a ; � » m a w/ ( ¢ c »§ \ / / 0 § w a s o 0 o n w o 7 ) � \ / (02 w 4-4 -H m o m w - : u e e e w / @ 2 e w w t ( 0 / e e m L w@ m e t cu U a U 0 > w/ § | � 0 CleanEarth"le Manifest# 2676238 GLOBAL JOB NUMBER: FACILITY APPROVAL NUMBER: 2=71ie?5— Please Check One: Earth of Carteret ❑Clean Earth of Maryland ❑Clean Earth of New Castle LI Clean Earth of Greater Washington N�-an iddlesex Avenue 1469 Oak Ridge Place 94 Pyles Lane 6250 Dower House Road Carteret,NJ 07008 Hagerstown,MD 21740 Now 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 Philadolphia ❑Clean Earth of North Jersey ❑Clean Earth of Southeast Pennsylvania ❑Othor...._. 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 T e or Print Clears G NERATOWS NAME& SITE ADDRESS: GROSS WEIGHT: q '2b M41 _ ons ❑Yards 'PARE.WEIGHT: V s DYards GENERATOR'S PHONE: eN 1GHT: ons [-]Yards DESCRIPTION OF MATERIAUSAMPLEJ11)AND LOCATION - Yl -- GENERATOR'S C' 11FICATION -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 cond' ' transportation according to all applicable state and federal regulations. Na F'4� Title: Sig Date and Time: TRANSPORTER Company: �t VAIr._ ) _ Phone Number: Address: Truck#and License Plate: Driver: SW Haulers Permit#: (Type or Print(Acarly) (applicable state permitfl I hereby certify that 1he above named material was picked up at the site MIisted tbove. Driver Signature: Date and'rime: 4 L ^ I Itcloy certify tit the above ped material was delivered without incident to hi C c lity noted above. Driver Signature: ''WA _Date and"Time: l O 1 Z 1 hereby certif t the above named material has been accepted at the above referenced facility. Authorized Signature: _ Date and'Time: y 2� FACILITY ft"W 1/5f8 ITEM♦CF W W00 f RHYS WUNUE PLAINIM G.W.1-48&A01-61S PHOEVX ',,i,� Environmental laboratories. Inc. Friday, October 27, 2023 Attn: Donnie Feeney Innov8tive Environmental Services 392 Columbus Ave Valhalla NY 10595 Project ID: 1 EDGEWOOD DR RYE BROOK SDG ID: GCP28442 Sample ID#s: CP28442 - CP28444 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 Page 1 of 14 j 0 11A ACCpg0 PH0EV1Yti�� qti Environmental Laboratories, Inc. ` NY# 11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference October 27, 2023 SDG I.D.: GCP28442 Project ID: 1 EDGEWOOD DR RYE BROOK Client Id Lab Id Matrix BOTTOM CP28442 SOIL 3 WALL COMP-NSE CP28443 SOIL W WALL UNDER HOUSE CP28444 SOIL Page 2 of 14 �N ACCp90 PHOENIX Ayc U � 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 October 27, 2023 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 10/17/23 13:30 Location Code: INNOVAT Received by: SW 10/18/23 15:13 Rush Request: 5 Day Analyzed by: see"By"below P.O.#: Laboratory Data SDG ID: GCP28442 Phoenix ID: CP28442 Project ID: 1 EDGEWOOD DR RYE BROOK Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 90 % 10/18/23 CV SW846-%Solid Soil Extraction for SVGA PAH Completed 10/18/23 H/M SW3546 Volatiles- STARSICP-51 1,2,4-Trimethylbenzene 0.76 0.67 ug/Kg 1 10/19/23 JLI SW8260D 1,3,5-Trimethylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D Benzene ND 1.3 ug/Kg 1 10/19/23 JLI SW8260D Ethylbenzene ND 1.3 ug/Kg 1 10/19/23 JLI SW8260D Isopropylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D m&p-Xylene ND 1.3 ug/Kg 1 10/19/23 JLI SW8260D Methyl t-Butyl Ether(MTBE) ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D Naphthalene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D n-Butylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D n-Propylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D o-Xylene ND 1.3 ug/Kg 1 10/19/23 JLI SW8260D p-Isopropyltoluene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D sec-Butylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D tert-Butylbenzene ND 0.67 ug/Kg 1 10/19/23 JLI SW8260D Toluene ND 1.3 ug/Kg 1 10/19/23 Al SW8260D Total Xylenes ND 1.3 ug/Kg 1 10/19/23 JLI SW8260D QA/QC Surrogates % 1,2-Dichlorobenzene-d4 96 % 1 10/19/23 JLI 70-130% % Bromofluorobenzene 99 % 1 10/19/23 JLI 70-130% • Dibromofluoromethane 91 % 1 10/19/23 JLI 70-130% •Toluene-d8 91 % 1 10/19/23 JLI 70-130% Ver 1 Page 3 of 14 Project ID: 1 EDGEWOOD DR RYE BROOK Phoenix I.D.: CP28442 Client ID: BOTTOM RL/ Parameter Result PQL Units Dilution Date/Time By Reference Sem ivo lati les-STARS/C P-51 Acenaphthene ND 250 ug/Kg 1 10/19/23 MR SW8270D Acenaphthylene ND 250 ug/Kg 1 10/19/23 MR SW8270D Anthracene ND 250 ug/Kg 1 10/19/23 MR SW8270D Benz(a)a nth race ne ND 250 ug/Kg 1 10/19/23 MR SW8270D Benzo(a)pyrene ND 250 ug/Kg 1 10/19/23 MR SW8270D Benzo(b)fluoranthene ND 250 ug/Kg 1 10/19/23 MR SW8270D Benzo(ghi)perylene ND 250 ug/Kg 1 10/19/23 MR SW8270D Benzo(k)fluoranthene ND 250 ug/Kg 1 10/19/23 MR SW8270D Chrysene ND 250 ug/Kg 1 10/19/23 MR SW8270D Dibenz(a,h)anthracene ND 250 ug/Kg 1 10/19/23 MR SW8270D Fluoranthene ND 250 ug/Kg 1 10/19/23 MR SW8270D Fluorene ND 250 ug/Kg 1 10/19/23 MR SW8270D Indeno(1,2,3-cd)pyrene ND 250 ug/Kg 1 10/19/23 MR SW8270D Naphthalene ND 250 ug/Kg 1 10/19/23 MR SW8270D Phenanthrene ND 250 ug/Kg 1 10/19/23 MR SW8270D Pyrene ND 250 ug/Kg 1 10/19/23 MR SW8270D QA/QC Surrogates %2-Fluorobiphenyl 85 % 1 10/19/23 MR 30-130% • Nitrobenzene-d5 81 % 1 10/19/23 MR 30-130% •Terphenyl-d14 75 % 1 10/19/23 MR 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 October 27,2023 Reviewed and Released by:Anil Makol,Project Manager Ver 1 Page 4 of 14 ACC09pq PHPHOENIX41 c U � 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 October 27, 2023 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 10/17/23 13:30 Location Code: INNOVAT Received by: SW 10/18/23 15:13 Rush Request: 5 Day Analyzed by: see"By"below P.O.#. Laboratory Data SDG ID: GCP28442 Phoenix ID: CP28443 Project ID: 1 EDGEWOOD DR RYE BROOK Client ID: 3 WALL COMP-NSE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 82 % 10/18/23 CV SW846-%Solid Soil Extraction for SVOA PAH Completed 10/18/23 H/M SW3546 Volatiles-STARS/CP-51 1,2,4-Trimethylbenzene 3.6 0.49 ug/Kg 1 10/19/23 JLI SW8260D 1,3,5-Trimethylbenzene 0.88 0.49 ug/Kg 1 10/19/23 JLI SW8260D Benzene ND 0.98 ug/Kg 1 10/19/23 JLI SW8260D Ethylbenzene ND 0.98 ug/Kg 1 10/19/23 Al SW8260D Isopropylbenzene ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D m&p-Xylene 2.4 0.98 ug/Kg 1 10/19/23 JLI SW8260D Methyl t-Butyl Ether(MTBE) ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D Naphthalene 1.0 0.49 ug/Kg 1 10/19/23 JLI SW8260D n-Butylbenzene ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D n-Propylbenzene 0.54 0.49 ug/Kg 1 10/19/23 JLI SW8260D o-Xylene 1.2 0.98 ug/Kg 1 10/19/23 JLI SW8260D p-Isopropyltoluene ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D sec-Butylbenzene ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D tert-Butylbenzene ND 0.49 ug/Kg 1 10/19/23 JLI SW8260D Toluene ND 0.98 ug/Kg 1 10/19/23 JLI SW8260D Total Xylenes 3.60 0.98 ug/Kg 1 10/19/23 JLI SW8260D QA/QC Surrogates • 1,2-Dichlorobenzene-d4 94 % 1 10/19/23 JLI 70-130% •Bromofluorobenzene 96 % 1 10/19/23 JLI 70-130% •Dibromofluoromethane 95 % 1 10/19/23 JLI 70-130% •Toluene-d8 91 % 1 10/19/23 JLI 70-130% Ver 1 Page 5 of 14 Project ID: 1 EDGEWOOD DR RYE BROOK Phoenix I.D.: CP28443 Client ID: 3 WALL COMP-NSE RL/ Parameter Result PQL Units Dilution Date/Time By Reference SemivolatilesSTARS/CP-51 Acenaphthene ND 280 ug/Kg 1 10/19/23 MR SW8270D Acenaphthylene ND 280 ug/Kg 1 10/19/23 MR SW8270D Anthracene ND 280 ug/Kg 1 10/19/23 MR SW8270D Benz(a)a nth race ne ND 280 ug/Kg 1 10/19/23 MR SW8270D Benzo(a)pyrene ND 280 ug/Kg 1 10/19/23 MR SW8270D Benzo(b)fluoranthene ND 280 ug/Kg 1 10/19/23 MR SW8270D Benzo(ghi)perylene ND 280 ug/Kg 1 10/19/23 MR SW8270D Benzo(k)fluoranthene ND 280 ug/Kg 1 10/19/23 MR SW8270D Chrysene ND 280 ug/Kg 1 10/19/23 MR SW8270D Dibenz(a,h)a nth race ne ND 280 ug/Kg 1 10/19/23 MR SW8270D Fluoranthene ND 280 ug/Kg 1 10/19/23 MR SW8270D Fluorene ND 280 ug/Kg 1 10/19/23 MR SW8270D Ind eno(1,2,3-cd)pyrene ND 280 ug/Kg 1 10/19/23 MR SW8270D Naphthalene ND 280 ug/Kg 1 10/19/23 MR SW8270D Phenanthrene ND 280 ug/Kg 1 10/19/23 MR SW8270D Pyrene ND 280 ug/Kg 1 10/19/23 MR SW8270D QA/QC Surrogates %2-Fluorobiphenyl 80 % 1 10/19/23 MR 30-130% % Nitrobenzene-d5 72 % 1 10/19/23 MR 30-130% %Terphenyl-d14 80 % 1 10/19/23 MR 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 October 27,2023 Reviewed and Released by:Anil Makol,Project Manager Ver 1 Page 6 of 14 V N ACC090PHOEVIX 0 Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY#11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Donnie Feeney Innov8tive Environmental Services October 27, 2023 392 Columbus Ave Valhalla NY 10595 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 10/17/23 13:30 Location Code: INNOVAT Received by: SW 10/18/23 15:13 Rush Request: 5 Day Analyzed by: see"By' below P.O.#. Laboratory Data SDG ID: GCP28442 Phoenix ID: CP28444 Project ID: 1 EDGEWOOD DR RYE BROOK Client ID: W WALL UNDER HOUSE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 89 % 10/18/23 CV SW846-%Solid Soil Extraction for SVOA PAH Completed 10/18/23 H/M SW3546 Volatiles- STARSICP-51 1,2,4-Trimethylbenzene 1900 26 ug/Kg 50 10/19/23 JLI SW8260D 1,3,5-Trimethylbenzene 570 26 ug/Kg 50 10/19/23 JLI SW8260D Benzene ND 52 ug/Kg 50 10/19/23 JLI SW8260D Ethylbenzene 84 52 ug/Kg 50 10/19/23 JLI SW8260D Isopropylbenzene 140 26 ug/Kg 50 10/19/23 JLI SW8260D m&p-Xylene 950 52 ug/Kg 50 10/19/23 JLI SW8260D Methyl t-Butyl Ether(MTBE) ND 26 ug/Kg 50 10/19/23 JLI SW8260D Naphthalene 490 26 ug/Kg 50 10/19/23 Al SW8260D n-Butylbenzene 370 26 ug/Kg 50 10/19/23 JLI SW8260D n-Propylbenzene 390 26 ug/Kg 50 10/19/23 JLI SW8260D o-Xylene ND 52 ug/Kg 50 10/19/23 JLI SW8260D p-Isopropyltoluene 170 26 ug/Kg 50 10/19/23 JLI SW8260D sec-Butylbenzene 260 26 ug/Kg 50 10/19/23 JLI SW8260D tert-Butylbenzene ND 26 ug/Kg 50 10/19/23 JLI SW8260D Toluene ND 52 ug/Kg 50 10/19/23 JLI SW8260D Total Xylenes 950 52 ug/Kg 50 10/19/23 JLI SW8260D QA/QC Surrogates 1,2-Dichlorobenzene-d4(50x) 96 % 50 10/19/23 JLI 70-130% Bromofluorobenzene(50x) 104 % 50 10/19/23 JLI 70-130% Dibromofluoromethane(50x) 94 % 50 10/19/23 JLI 70-130% Toluene-d8(50x) 88 % 50 10/19/23 JLI 70-130% Ver 1 Page 7 of 14 Project ID: 1 EDGEWOOD DR RYE BROOK Phoenix I.D.: CP28444 Client ID: W WALL UNDER HOUSE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Sem ivolatilesSTARS/CP-51 Acenaphthene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Acenaphthylene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Anthracene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Benz(a)anthracene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Benzo(a)pyrene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Benzo(b)fluoranthene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Benzo(ghi)perylene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Benzo(k)fluoranthene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Chrysene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Di benz(a,h)a nth race ne ND 260 ug/Kg 1 10/19/23 KCA SW8270D Fluoranthene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Fluorene 310 260 ug/Kg 1 10/19/23 KCA SW8270D Indeno(1,2,3-cd)pyrene ND 260 ug/Kg 1 10/19/23 KCA SW8270D Naphthalene 700 260 ug/Kg 1 10/19/23 KCA SW8270D Phenanthrene 360 260 ug/Kg 1 10/19/23 KCA SW8270D Pyrene ND 260 ug/Kg 1 10/19/23 KCA SW8270D QA/QC Surrogates %2-Fluorobiphenyl 90 % 1 10/19/23 KCA 30-130% % Nitrobenzene-d5 78 % 1 10/19/23 KCA 30-130% %Terphenyl-d14 55 % 1 10/19/23 KCA 30-130% RUPQL=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: Volatile Comment: Elevated reporting limits for volatiles due to the presence of target and/or non-target compounds. All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If you are the client above and have any questions concerning this testing,please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. Phyllis hiller, Laboratory Director October 27,2023 Reviewed and Released by:Anil Makol, Project Manager Ver 1 Page 8 of 14 N A C C p H�qy PHOCVIX��,5, Environmental Laboratories, Inc. 587 East Middle Turnpike, P.O.Box 370,Manchester,CT 06045 NY#11301 QA/QC Report Tel.(860)645-1102 October 27, 2023 QA/QC Data SDG I.D.: GCP28442 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits Limits QA/QC Batch 702403(ug/kg), QC Sample No:CP28098(CP28442,CP28443,CP28444) Polynuclear Aromatic HC - Soil Acenaphthene ND 230 66 71 7.3 72 69 4.3 30-130 30 Acenaphthylene ND 230 64 69 7.5 73 69 5.6 40-140 30 Anthracene ND 230 74 85 13.8 87 79 9.6 40-140 30 Benz(a)anthracene ND 230 68 79 15.0 77 78 1.3 40-140 30 Benzo(a)pyrene ND 230 80 91 12.9 84 87 3.5 40-140 30 Benzo(b)fluoranthene ND 230 66 71 7.3 79 88 10.8 40-140 30 Benzo(ghi)perylene ND 230 73 93 24.1 75 75 0.0 40-140 30 Benzo(k)fluoranthene ND 230 70 67 4.4 76 74 2.7 40-140 30 Chrysene ND 230 70 77 9.5 79 81 2.5 40-140 30 Dibenz(a,h)anthracene ND 230 73 92 23.0 82 73 11.6 40-140 30 Fluoranthene ND 230 78 88 12.0 91 103 12.4 40-140 30 Fluorene ND 230 70 76 8.2 78 73 6.6 40-140 30 Indeno(1,2,3-cd)pyrene ND 230 71 90 23.6 75 74 1.3 40-140 30 Naphthalene ND 230 63 69 9.1 69 65 6.0 40-140 30 Phenanthrene ND 230 73 83 12.8 89 99 10.6 40-140 30 Pyrene ND 230 76 86 12.3 89 98 9.6 30-130 30 %2-Fluorobiphenyl 76 % 65 70 7.4 68 68 0.0 30-130 30 %Nitrobenzene-d5 74 % 62 69 10.7 64 65 1.6 30-130 30 %Terphenyl-d14 70 % 66 72 8.7 62 58 6.7 30-130 30 QA/QC Batch 702686(ug/kg),QC Sample No:CP29010(CP28442,CP28443) Volatiles - Soil (Low Level) 1,2,4-Trimethylbenzene ND 1.0 93 100 7.3 70-130 30 1,3,5-Trimethylbenzene ND 1.0 95 101 6.1 70-130 30 Benzene ND 1.0 87 92 5.6 70-130 30 Ethylbenzene ND 1.0 93 97 4.2 70-130 30 Isopropylbenzene ND 1.0 96 99 3.1 70-130 30 m&p-Xylene ND 2.0 92 95 3.2 70-130 30 Methyl t-butyl ether(MTBE) ND 1.0 93 98 5.2 70-130 30 Naphthalene ND 5.0 97 101 4.0 70-130 30 n-Butylbenzene ND 1.0 97 104 7.0 70-130 30 n-Propylbenzene ND 1.0 96 101 5.1 70-130 30 o-Xylene ND 2.0 92 96 4.3 70-130 30 p-Isopropyltoluene ND 1.0 96 103 7.0 70-130 30 sec-Butylbenzene ND 1.0 95 100 5.1 70-130 30 tert-Butylbenzene ND 1.0 97 102 5.0 70-130 30 Toluene ND 1.0 94 99 5.2 70-130 30 •1,2-dichlorobenzene-d4 95 % 102 102 0.0 70-130 30 •Bromofluorobenzene 100 % 98 97 1.0 70-130 30 •Dibromofluoromethane 95 % 99 96 3.1 70-130 30 •Toluene-d8 91 % 100 102 2.0 70-130 30 Page 9 of 14 QA/QC Data SDG I.D.: GCP28442 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits Limits Comment: The Low Level 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 Tdchlorofluoromethane-HL. QA/QC Batch 702686H(ug/kg),QC Sample No:CP29010 50X(CP28444(50X)) Volatiles - Soil (High Level) 1,2,4-Trimethylbenzene ND 250 102 104 1.9 102 104 1.9 70-130 30 1,3,5-Trimethylbenzene ND 250 103 105 1.9 103 105 1.9 70-130 30 Benzene ND 250 92 94 2.2 92 96 4.3 70-130 30 Ethylbenzene ND 250 101 102 1.0 101 103 2.0 70-130 30 Isopropylbenzene ND 250 101 105 3.9 104 107 2.8 70-130 30 m&p-Xylene ND 250 99 100 1.0 100 101 1.0 70-130 30 Methyl t-butyl ether(MTBE) ND 250 95 95 0.0 90 93 3.3 70-130 30 Naphthalene ND 250 102 100 2.0 96 100 4.1 70-130 30 n-Butylbenzene ND 250 108 110 1.8 107 109 1.9 70-130 30 n-Propylbenzene ND 250 105 109 3.7 106 108 1.9 70-130 30 o-Xylene ND 250 99 99 0.0 98 100 2.0 70-130 30 p-Isopropyltoluene ND 250 106 108 1.9 105 108 2.8 70-130 30 sec-Butylbenzene ND 250 102 104 1.9 103 106 2.9 70-130 30 tert-Butylbenzene ND 250 103 106 2.9 105 107 1.9 70-130 30 Toluene ND 250 100 101 1.0 100 103 3.0 70-130 30 %1,2-dichlorobenzene-d4 94 % 100 100 0.0 102 100 2.0 70-130 30 %Bromofluorobenzene 98 % 99 98 1.0 97 97 0.0 70-130 30 %Dibromofluoromethane 93 % 98 96 2.1 96 94 2.1 70-130 30 %Toluene-d8 92 % 100 101 1.0 101 102 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. If there are any questions regarding this data, please call Phoenix Client Services at extension 200. RPD-Relative Percent Difference LCS-Laboratory Control Sample LCSD-Laboratory Control Sample Duplicate MS-Matrix Spike Phyllis hiller, Laboratory Director MS Dup-Matrix Spike Duplicate Octob r 27,2023 NC-No Criteria Intf-Interference Page 10 of 14 f« 2 Z) \ CM k/ « o {� �\ � �/ §j f � bQ 6 C 7� §k k/ 2 a §{ CO /0 g ){ § ) o 4 f ) I $ \ m 7 \ {) 0 \ 7) ru $ 7 ® �LL E W 04 0 $cof© 04( k ak % \ ; § m k{ U G §$ @ 2< co W , ��{/ § z /§ a k) \ \( »tea 4D t 2/ 2 < k L®/ E x EDT » 0£ & i f0 ƒ @ >a 0 CN / Sa \ \ ) 2 T� k #- $ b / } - 2 § w \ f ) o $ j / k / CL E § 0k� » $ o § E [ o N accogo PH0E1VIXk*,"--!�'0 ����� �ti, U d` � 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 October 27, 2023 SDG I.D.: GCP28442 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: None. Page 12 of 14 C N ACCOg0 PHOffjX �.. qy� — e � J 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 NY Temperature Narration October 27,2023 SDG I.D.: GCP28442 The samples in this delivery group were received at 1.3°C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 13 of 14 6ZOZ/l AGH L&13d z z 8 U W O n N r , J E 0iz u r ii o n o $ y� ( �l�b�° U a a s v IL o c s, m m O O-► �2e "b d O �� J V (n l0 a 0 �� J ,,e°� � ° o=o o momo� r 0 _ y�� 4 � UyUmUmUUEUsm o x f0 'tL 4b O vl v> mu)w v�yycnEa d LL w �/ �0 O a r C r m n m W n o r 9 a ° Lj.JVCEID c� <nw o7�x�U ❑ is � � ZI ❑ ❑ ❑ ❑ ❑ O r �`f51C-A C f0 m L_ yL'a C U Cl) 000 N O w z EU E s U m H � W ❑ ❑ ❑ ❑ ❑ ' a N w C r 01 O U C N O a Nov In iq rc�aa A Z z f0 O N V 0 c CO J F❑❑❑ ❑ ❑ O ° n ou o a Ud V Q o Pra E w o LU m y N o 0 0 N n �r = uya 0) U ~ m a C7 c m o rJ w z z a o IL � Z El El [I El 77 W m N _ a�CL O Om m EEM cn x Icon _ F m — o U) E m x T w d v € C Y W d lL r x wO fA o m m Em Q a w a 0 El El 1:1 El 3 E V/ E S 7 � c N 0 O � t U a 0 \ b s i7 e D V i h CD o m cl m m U, E o-i In 8 c -O 3 o aCi E E 3 v ° v 3 .R 'r C37 ip U m � y } m E y v Zo u C �m Q ww U) � o 0 N n J O N m my Q n� di Co - E ry C e L�ry PAYMENT RECEIPT 0 Brookfield Resource Managernerit 100 Lamont Street Elmsford, NY 10523 914-592-5250 Receipt:1827 762 Date:10/17/2023 Customer:69802 Time:2 36 07 PM INNOVATIVE ENVIRONMENTAL 392 COLUMBUS AVE VALHALLA, NY 10595 ID Number: Ticket:1879777 Weigh In:r0/17/"1023 228:19 f-M, Operator:Romy C Weigh Out:10!17/2023 2.36-05 Pm Commodity Gross Tare - Net Price TOTAL$ Tanks 15.300 12.780 2,520 2.2300/ :W 56.20 ----------------------------------------- Ticket Total: 50.20 No,of Tickets:1 EZCash Paid: $66.00 Payment Method:EZCaslt Round Amt: ($0.20) Total Paid: $56, For current pricing,Hours and contact infoimatlon check us out on the web @brookfieldecrap.com Join Brookfield Scrap on Facebook Qq webuyscrap 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. WASTE MANIFEST Docu Manifest 2 Page Document No. 1 Of 1 3.Generator's Name and Mailing Address 4.Generators Phone 6.Transporter 1 Company Name 8 US Innov8tive Environmental Services N R 0 EPA 0 2ber3 9 2 1 0 A.State Transporters ID B.Transporter 1 Phone 914-4 4 9-6608 7.Transporter 2 Company Name A US EPA ID Number C.State Transporter's ID D.Transporter 2 Phone 9.Designated Facility Name and Site Address 10. US EPA ID Number Water Works N Y D 9 8 6 9 0 8 0 g 5 E.State Facility's ID be 77 Stewart Ave Newburgh, NY F.Facility's Phone 845-561-4111 11.WASTE DESCRIPTION 12. Ccnlainers 13. 14. Total Unit a. No. Type Quantity Wt./Vol. Non RCRA, Non DOT liquid (Oily Water) 1 T T Gallon G b. E N E R c. A T 0 W R d F- N ' G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above C0 D Q Q Q15.Special Handling Instructions and Additional Information ZApproval O Z 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are lully and accurately described and are in al respects in proper condition for transport.The materials described on this manifest are not subject to lederal hazardous waste regulations. Printed/Typed Name Date i nature Donald Feeney - As Agent for Me Day Year T 17.Transporter 1 Acknowledgement of Receipt of Materials \ 2 "?123 R A Printed/Typed Name Date NSignature s Sean Penelle Month Day Year P O 18.Transporter 2 Acknowledgement of Receipt of Materials R Printed/Typed Name Date E Signature Month Day Year R 19.Discrepancy Indication Space F 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 I T Printed/Typed Name Date Signature Y Month Day Year m o` ' 19f32'�� BUILDING DEPARTMENT UI ING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - -- - - - - - -- - - - - -- - - - - ADDRESS:_ ' �C Q$ DATE:- J� rc' PERMIT# -' � tS6 ^� r ISSUED - CT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ L`7� NAILED /:1>8PECTION ❑ SITE INSPECTION❑ FOOTING �lOUIRED ❑ FOOTING DRAINAGE 1 ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas _ ❑ FUEL TANK ` � ��`e Z�\CQ cl\ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING 1 ❑ CROSS CONNECTION Y - ❑ FINAL ❑ OTHER Nc �,, e CL@AN@A_ RTH Mate EXHIBIT A Global Job# Material Profile Sheet Sales Rep RECYCLING 8 DISPOSAL SOLUTIONS 0 Clean Earth of Carteret ❑ Clean Earth of Maryland ❑ Clean Earth of Southeast Pennsylvania ❑ 24 Middlesex Avenue 1469 Oak Ridge Place 7 Steel Road East Carteret,NJ 07008 Hagerstown,MD 21740 Morrisville,PA 19067 T 732-541-8909 T 301-791-6220 T 215-428-1700 ❑ Clean Earth of Philadelphia ❑ Clean Earth of New Castle ❑ Clean Earth of Greater Washington 3201 South 61st Street 94 Pyles Lane 6250 Dower House Road Philadelphia,PA 19153 New Castle,DE 19720 T 215-724-5520 T 302-427-6633 T 301 Marlboro,MD 20772 T 01-599-0939 A.Waste Generator/Job Site Information 1. Generator Name: Theresa Zampaglione 8. Job Site Name: Theresa Zampaglione 2. Generator Address: 1 Edgewood Dr 3. Generator Cty/SUZip: Rye Brook NY 10573 9. Job Site Address: 1 Edgewood Dr 10. Job Site Cty/SUZip: Rye Brook NY 10573 4. Generator Phone: 11. Job Site Phone: 914-449-6608 5. Generator Contact: 12. Job Site Contact: Donnie Feeney 6. Generator Email: 13. Job Site Email: service@innov8enviro.com Generator County: Westchester @innov8enviro.com 14. Job Site County: Westchester Billing Information 15. Customer Name. Innov8tive Environmental Services Inc 16. Customer Address: 392 Columbus Avenue 18. Customer Phone: 914-449-6608 17. Customer Cty/SUZip: Valhalla,NY 10595 19. Customer Contact: Norine Meyer 20. Customer Email: service@innov8enviro.com B. Waste Stream Information 1. Name of waste: #2 Home heating fuel 2. State waste code(s)(if applicable): N/A 3. Process generating waste(attach separate sheet, if necessary): Removal of leaking oil tank 4. Is this waste a soil amendment(i.e., bio-solids, paper pulp sludge, lime neutralized industrial water sludge, potable water treatment plant sludge)? ❑Yes ❑ No N/A 5. Estimated quantity of waste: 20 Tons El Cubic Yards ❑Drums 6. Term of project: ❑Recurring ❑One Time C. Waste Composition/Characteristics 1. Source of contamination(i.e., UST, AST, leak, spill, non-specific, etc.): Leaking oil tank 2. Type of contamination (i.e., diesel, gasoline,waste oil, heating oil, MGP, etc.): #2 Home heating fuel 3. Contaminants of concern: #2 Home heating fuel 4. Provide a site history detailing past and present land uses, on site storage/process information, and any activities related to contaminants of concern (attach a separate sheet if necessary): Residential 5. Composition of waste(clay, rock, sand, debris, moisture. Soil 100 % % chemical constituents, contaminants,etc.). Should equal 100%: o, 6. Is this site a State or Federal Superfund Site? 7. Is this site enrolled in or subject to any City or state environmental programs? ❑Yes ©No 7a. If yes, provide program name and site number ❑Yes 0 No 8. Is a laboratory report being supplied with this profile? 8a. If yes, you will need to attach a sampling plan description and a diagram of sampling locations that ties to the ❑Yes No data. Please refer to the"Site Sampling Diagram"form in the approval package for guidance. 9. Is the waste represented in this profile classified as a radioactive material under USEPA 40 CFR 191.12 or other applicable regulatory provisions? ❑Yes X❑No 10. Does this waste contain any levels of polychlorinated biphenyls(PCBs)? 10a. If yes, list the level: []Yes ®No 10b. If yes, is the waste material TSCA-regulated or defined as a PCB remediation waste under TSCA? ❑Yes []No F1 N!A Revised 3/1/19 PLEASE PRINT IN INK OR TYPE Page 1 of 2 C. Waste Composition/Characteristics (continued Global Job# � Sales Rep 11. Does this waste contain herbicides, pesticides, asbestos, insecticides or residues thereof at concentrations that would render it hazardous as defined by 40 CFR Part 261 or be subject to additional state or federal regulations? El Yes No 12. Is the waste represented in this profile generated as a result of corrective action taken under the RCRA Underground Storage Tank Regulations found in 40 CFR Part 280? ❑Yes X❑No 13. Is the waste a dioxin bearing waste? 14. Is the waste a treatment residue from a previously listed or characteristic hazardous waste? ❑Yes ®No 15. Is there a nuisance level of odor associated with this waste? ❑Yes Q No 16. Are there any special handling instructions for management of this waste? ❑Yes No 17. Have any odor suppressing foams or absorbents been added to the waste? ❑Yes ©No 18. Does this waste contain Coal Combustion By-products(CCB)., e.g., Fly Ash. Slag? ❑Yes ®No (Applicable to Maryland facilities.) ❑Yes X❑No ❑N/A 19. If yes to any of the above questions, please explain (attach an additional sheet if necessary): D. Generator/Agent Certification 1. I certify that the waste represented by this profile is not a listed hazardous waste, nor does it contain a listed hazardous waste, nor does it exhibit any characteristics of a hazardous waste as defined by 40 CFR Part 261. ©Yes ❑No 2. 1 certify that this profile and all attachments contain true and accurate descriptions of the waste material. 3. 1 certify that all relevant information in possession of the Generator/Agent pertaining to known or suspected hazards ®Yes ❑No with regard to the waste has been disclosed to Clean Earth. ®Yes No 4. 1 certify that all changes that occur in the characteristics of the waste will be identified by the Generator/Agent and disclosed to Clean Earth prior to providing the waste to Clean Earth. ®Yes No 5 1 certify that the analytical data attached hereto are derived from testing representative sample(s)as referenced in 40 CFR 261.20 or an equivalent state regulatory provision. ❑Yes ❑No ❑■ NIA 6 For sites that contain "clean fill,"the undersigned certifies that a site investigation was conducted and that the �E soil was characterized according to the proposed Clean Earth facility(ies)acceptance criteria for soil u Yes []No ❑N/A classification as"clean fill"and where applicable in accordance with the Pennsylvania Management of Fill Policy. 7 The undersigned has determined the non-hazardous status of said waste in accordance with 40 CFR 262.11. Should, at any time after delivery, the material accepted by Clean Earth be found to be non-conforming to the Yes ❑No information certified in this profile and represented by documentation attached hereto, it becomes the responsibility of the Generator/Agent to remove the waste from the designated Clean Earth facility within five(5)calendar days of notification. Notification is to be verbal followed by written notification, overnight receipted. It is the Generator's/ Agent's responsibility to abide by all Federal, State and Local regulations associated with the removal of their waste. If the waste is not removed within the specified time period, said disposal shall be arranged by a Clean Earth representative and billed to the Generator/Agent at cost plus basis. Furthermore, the Generator/Agent will be responsible for any and all costs for decontamination required by the Clean Earth facility that is related to the Generator's/Agent's material and all liability for such non-conforming waste shall revert to Generator/Agent. Signature_.` �� �"'� ', L� Date: Name(type or print): Donnie Feeney Company: Innovative Environmental Services E. Clean Earth Waste Approval Decision 1. Treatment Option(s): 2. Proposed Treatment Facility(ies): 3. Supplemental information(special handling, hours of acceptance. etc.): 4. Approval decision: ❑Approved ❑Denied Approved tonnages: 4a. If denied, please indicate the reason in the space provided: 5. Approval Signature: Date: 6. Facility Manager's Signature: Date: Revised 3/1/19 PLEASE PRINT IN INK OR TYPE Page 2 of 2 From WINSUPPLY ELMSFORD NY CO To Reorder Dial: 914-345-0344 REPRINT 141 SOUTH CENTRAL AVE Fax: 914-345-0341 ELMSFORD. NY 10523 Sold To INNOVBTIVE ENVIRONMENTAL SRVCSShip To - Innovative Environmental Servi * * * * * * * Date 8/18/23 392 COLUMBUS AVE 392 Columbus Ave PACKING LIST Page - 1 * * * * * * * Time 13.07.53 VALHALLA. NY 10595-1306 VALHALLA. NY 10595 WISEMA Customer No.- 002863 914-449-6608 62381-01 NO RTN ELECTRICAL/NO RTN SPECIAL ORDER/RTN SUBJ TO RESTOCK FEE Order No.�3*-833 Check # 8333 ----------------------------- -------------------------------------------------- Date Shipped 8/18/23 Date Ordered - 8/17/23 Date Requested 8/18/23 Date Printed - 8/18/23 Filled By Ordered By - service@ Cust. Order # - 1 Edgewood Or Ship Via OUR TRUCK Salesman # - 031 Job Name 1 Freight .00 Taken By - ECOMM ------------------------------------------------------------------------- _ _ Original In Line Bin Extended Fr No. of Order Shipped On B/O Hold UM Description/Stock Number No. Location Weight C1 Packages -------- ---- -- ------- ----- -- ------------------------------ ---- ------------- ---------- -- 1 EA 204701 275GAL HORIZ OIL TANK 12.0 OUTS -------- 3028204701 1 1 EA 4503 1-112 & 2" HORZ KING FILL 13.0 44A1 30144503 1 1 EA 88005687 112 LFFBV-3C-M1 BV 11.0 54A1 THREADED 077088005687 1 1 EA 2 BLK 150 MI SQR HEAD PLUG CN 8.0 54D6 1337ZMBPL08 2 2 EA 1/2X3-1/2 BLK STL NIPL IMP 6.0 58B6 1337ZNB03312 1 1 EA 112 BLK 150 MI 90 ELBOW CN 7.0 7A1 1337ZMBL9003 1 1 EA 14517 2X2 VENT FILL ALARM 10.0 7A6 4517 301814517 4 4 EA 1-1/4X8 BLK STL NIPL IMP 9.0 7B1 1337ZNB068 4 4 EA 1-1/4 BLK MI FLOOR FLANGE 1.0 782 031010560 1 1 EA 4025 2 THRD MUSHROOM VENT CAP 3.0 783 E107A999S 30144025 1 1 EA OF-21 FASTFILL ALL WEATHER CAP 4.0 7B4 OF-21 3010UF21 1 1 EA OF-47 2" FEMALE 45 FASTFILL 5.0 785 UF47 3010UF47 1 1 EA 48-8-8 1/2FL X 1/2MIP ADPT 2.0 7C2A1 14084888 Customer Signature: ** MATERIAL RECEIVED IN GOOD CONDITION ** From WTNSUPPLY ELMSFORD NY CO To Reorder Dial: 914-345-0344 REPRINT 141 SOUTH CENTRAL AVE Fax: 914-345-0341 ELMSFORD, NY 10523 Sold To INNOV8TIVE ENVIRONMENTAL SRVCSShip To - Innovative Environmental Servi 392 COLUMBUS AVE Date - 8/18/23 392 Columbus Ave PACKING LIST Page 2 * * * * * * * Time 13.07.53 VALHALLA, NY 10595-1306 VALHALLA. NY 10595 WISEMA 914-449-6608 Customer No.- 002863 NO RTN ELECTRICAL/NO RTN SPECIAL ORDER/RTN SUBJ TO RESTOCK FEE Order No. - 362381.01 - Check # ************8333 --------------------------- -------------------------------------- -------------------------- ate Shipped - 8/18/23 --------------- Date Ordered 8/17/23 Date Requested - 8/18/23 Date Printed - 8/18/23 Filled By Ordered By service@ Cust. Order # - 1 Edgewood Or Ship Via - OUR TRUCK Salesman # 031 Job Name - 1 Freight - .00 Taken By ECOMM Original In ----------------------------------------------------------------------------------------- ___________ Line Bin Order Shipped On B/O Hold UM Description/Stock Number No. Location Extended Fr No. of - -- ------------------------------ ---- ------------- Weight Cl Packages ---------- -- -------- END OF PACKING LIST T&C:You agree that the sale of these products/services is subject to all of our standard terms and conditions of sale located at www.winsupplyinc.com/tcsale Customer Signature: ** MATERIAL RECEIVED IN GOOD CONDITION ** TRANSACTION RECORD _________________ CARD TYPE: VM CARD NUMBER: ************8333 EXP DATE: **/** REFERENCE #: P000661204 M AUTH #: 063214 f 1.197.93 SIGNATURE: SOLD TO DATE ORDERED ORDER TAKEN BY 10/17/23 PHONE NO. CUSTOMER ORDER# 1 Edgewood Dr LOB LOCATION Rye Brook NY IOBPHONE STARTING DATE TERMS CITY MATERIAL UNIT AMOUNT DESCRIPTION 1 mobilization of equipment 500.00 1 small excavator 1,600.00 1 PID meter 110.00 1 supervisor 650.00 2 laborers 550.00 1,1oo.00 1 service truck 250.00 1 vac service 625.00 162 gal of liquid disposal 1.50 243.00 1 roll 6 mil poly plastic 200.00 MISCELLANEOUS CHARGES 1 disposal facility sample 400.00 1 transportation to disposal facility 1,350.00 18.51 tons of contaminated soil disposal 98.00 1,813,98 1 transportation to disposal facility 1,350.00 15.97 tons of contaminated soil disposal 98.00 1,565.06 10 ground protection mats 45.00 450.00 TOTAL MISCELLANEOUS LABOR HIRS RATE AMOUNT TOTAL MATERIALS TOTAL LABOR SOLD TO DATE ORDERED ORDER TAKEN BY 10/18/23 PHONE NO. CUSTOMER ORDER N 1 Edgewood Dr JOB LOCATION Rye Brook NY JOB PHONE STARTING DATE TERMS QTY MATERIALAMOUNTUNIT 1 small excavator 1,600.00 1 supervisor 650.00 1 laborer 550.00 550.00 2 6 wheel dump trucks 850.00 1,700.00 MISCELLANEOUS CHARGES 10 ground protection mats 45.00 450.00 28 yds screened backfill material 42.00 1,176.00 TOTAL MISCELLANEOUS 3 8260-8270 Stars soil analysis 450.00 1,350.00LABOR HIRS RATE AMOUNT 1 NYSDEC closure report 800.00 TOTAL MATERIALS TOTAL LABOR ■ ■� N +c�v - -r v Em E N V 1 R O N M E N T A L S E R V I C E REMEDIATION JOB CHECKLIST Job Address: Date: Supervisor (Circle all that apply) Poonie Frank Al al h Se 7 Gabby Juan David Mechanic (Circle all that apply) Andy Jose Jarrett Other: Excavator(Circle) CAT304 AT ETrack Loader (Circle) Phil Cowell Other Rental (Type/Company) Rented Equipment (Circle) CAT301.7 Phil-120 Phil-160 Phil-290 Service Truck(Circle one) YES NO 6 Wheel Dump Truck (Circle one) YES- NO Vacuum Truck (Circle one) YES NO PID Meter(Circle one) YES NO Gallons Tons Quantity Yards Liquid Disposal - (Gallons) Containers Filled -(Quantity) Roll of Poly Lining(Quantity) Ground Protectant Mats(Quantity) Screened Back Fill -(Yards) Soil Sample- (Quantity) Confirm with Office additional Boxes needed Yes N/A Mechanic's Signature: Date: To be completed by office personnel: DO NOT WRITE BELOW THIS LINE! Clean Earth Scheduled Clean Earth Approval#s Global# Approval# Office Signature: Date: Total#of days on site: i N N G'p E N V I R O N M E N TA L REMEDIATION 1013 CHECKLIST Job Address: � Qw Date: 1-7 ro Supervisor (Circle all that apply) Donnie Frank Al Ralph Sean Gabby Juan David eor Mechanic(Circle all that apply) end Jos Jarrett Other: Excavator(Circle) CAT304 T CAT305 Track Loader (Circle) Phil Cowell Other Rental (Type/Company) Rented Equipment (Circle) CAT301.7 Phil-120 Phil-160 Phil-290 Service Truck(Circle one) YES NO 6 Wheel Dump Truck(Circle one) YES NO Vacuum Truck(Circle one) YES A Cd NO PID Meter(Circle one) YES NO Gallons Tons Quantity Yards Liquid Disposal - (Gallons) Containers Filled -(Quantity) Roll of Poly Lining(Quantity) Ground Protectant Mats(Quantity) ! Screened Back Fill-(Yards) 1 Soil Sample- (Quantity) d Confirm with Office additional Boxes needed Yes N/A Mechanic's Signature: Date: To be completed by office personnel: DO NOT WRITE BELOW THIS LINE! Clean EarthEScheduledEE Clean Earth Approval#s Global# Approval# Office Signature: Date: Total#of days on site: .. A` ��A��, ASj\A 'td ypBA- ; ^ �nP^ ''? "vl� ''�A A•..' 'eA'. 4e�TIn. ,gA�P'� Oar - D��.�• � ��: ,, `0�° �;,��,.,�Q� �I�,�r, ,; Q� �0 � �• �D� �'.� . v •♦ � � •c n v �+• ,cc•slit � �t� ♦ci +' � �" •• ' • r •• '• v �,�► .c• • `� ►....�' •��`-4N►O. f•� t.:•-.4N►ti+ � 3�=c; N/►r �:� .�e h 1►r+�.:a��%eais3�+. ►H -s �ro N►► :�M < » j `° A. N �•, --`.�'i4��e�, � U 1�1 •y:1 VCR � rl.. '*/ : ♦, W Of w LO o ction U a,. __++ Z to ..+ m 03 TZ > U Q aj >C , `\ '`• �; � G� � „ o °� .ram::•. i 00 `� ? M cd cT y r, rn co �� ,.,+►1,4 s �_�,'+r►{ r i _ f;• +►1++,' ��<. , f.rrr+H4 £ d►Hh ' - d► r *3°-�• r►1 ►+. sue • +1�1 i(/1 '" d►,I,i�1)�� tYJyy � ��►j►��,�11 ,{�T q�t I d�►j►�(j►1+ eft ®'gk� +71,►,�,�,1►1 �•rr *� 1�1,►,�,1 p� [ +,f�,,,(1 � Asir � �% -}��g€:r A 7���:;� ♦♦ , �A�Yf�'��ts. t �7 Ir�i ^ - Ili`"rd!`' ^ 11�Y�' Jl � ,t4,�, �t�t�u.. " ��.l+ry+��,, •�r " b(��'? �7F" " �u "•� ���}riil +7 `D �l.�h'r' �) '�i'}�H 44� D� '4�! �ki� � 4d 4/\'1 �` D °�}�i�.�4��� D t ' ® DATE(MM/DDIYYYY)AC� CERTIFICATE OF LIABILITY INSURANCE 2/6/2023 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(iss) 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 PHONE Evita Dermanis FAX P.O. Box 1689WC.No •914-205-7682 ('C. A/c No):914-205-7682 Pearl River NY 10965 ADDRESS: Evita.Dermanis@mtpcap.com INSURERS AFFORDING COVERAGE NAIC0 INSURER A:Century Surety Company 36951 INSURED INNOENVI -INSURER B:Progressive Casualty Insurance Company 24260 Innov8tive Environmental Services Inc. 392 Columbus Ave INSURERC: Valhalla NY 10595 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:16166041 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. LTR TYPE OF INSURANCE ADDL'SUBR POLICY NUMBER MOL M/DDY EFF PM/LDICDY EXP LIMITS A X COMMERCIAL GENERALLIABILrY CCP1108511 2/14/2023 2/14/2024 EACH OCCURRENCE $1,D00,000 CLAIMS-MADE DAMAGE TO RENTEff_ OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY 7 JET 1-1 LOC PRODUCTS-COMP/OP AGG $3,0DO,000 OTHER: $ B AUTOMOBILE LIABILITY 016663983 1/15/2023 1/15/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY eracddent AUTOS ONLY AUTOS ) i XI HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ I $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR Id CLAIMS-MADE AGGREGATE $ DED 1 1 RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A I Pollution Liability CCP1108511 2/14/2023 2/14/2024 Each Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/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 ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 Ctlnar� ©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 Fug-d PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ' . �- .0 A A A A A 824703808 N MT PLEASANT CAPACITY AGENCY T ■ 1 BLUE HILL PLAZA STE 1689 PEARL RIVER NY 10965 ❑�.��L 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 T4 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 792990792 U-26.3 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Sunday, September 24, 2023 10:40 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/24/2023 10:39 To: VIL RYE BROOK PRIMARY Transmitted: 09/24/2023 10:39 00001 Ticket: 09243-000-054-00 Type: Regular Previous Ticket: 08153-000-100-00 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: EDGEWOOD DR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ENTIRE PROPERTY NearSt: WOODLAND 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: 09/27/2023 Depth of excavation: Site dimensions: Start Date and Time: 09/27/2023 07:00 Must Start By: 10/12/2023 ------------------------------------------------------------------------------ Contact Name: SARAH MASSA Company: INNOVBTIVE ENVIRONMENTAL SERVICES Addr1: 392 COLUMBUS AVE Addr2: City: VALHALLA State- NY Zip: 10595 Phone: 914-449-6608 Fax: Email: service@innov8enviro.com Field Contact: NORINE MEYER Alt Phone: 914-449-6608 Email: service@innov8enviro.com Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Tuesday, August 15, 2023 7:03 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 08/15/2023 07:03 To: VIL RYE BROOK PRIMARY Transmitted: 08/15/2023 07:03 00001 Ticket: 08153-000-100-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: EDGEWOOD DR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ENTIRE PROPERTY NearSt: WOODLAND 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: 08/18/2023 Depth of excavation: Site dimensions: Start Date and Time: 08/18/2023 07:00 Must Start By: 09/01/2023 ------------------------------------------------------------------------------ Contact Name: SARAH MASSA Company: INNOVBTIVE 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 Alt Phone: 914-449-6608 Email: service@innov8enviro.com Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i