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HomeMy WebLinkAboutMP23-154 ttQyf�BRn�. .� Lwu a jJ t 4 J,+��•W v '� O 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 James Glucksman&Linda Glucksman 100 Brush Hollow Close Rye Brook,New York 10573 Re: 100 Brush Hollow Close, Rye Brook,New York 10573 Parcel ID#: 129.84-2-89 As per the Certification letter from Burke Energy dated December 21, 2023, the removal of an underground oil tank and installation of a new above-ground oil tank under Mechanical Permit #23-154 issued on 10/18/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRC�,�, O� 2m 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• , J �. \ 1\.Y-1 ! DATE• 2�2 PERMIT# ISSUED: 1�4� ECT: BLOCK: LOT: NJ LOCATION: kn OCCUPANCY: ❑ Violation Noted THE WORK IS... [9 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 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �E BR(�k, 1982 BUILDING DEPARTMENT UILDINGINSPECTOR ! ❑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# , '" I' � J l ISSUED: 'SECT: BLOCK: LOT: LOCATION: C�UV `^� IG� �,CUI�c� OCCUPANCY: ❑ Violation Noted Q THE WORK IS... ❑ PASSED FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ) ICE ❑ INSULATION c^ � ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ V N W y coo 00 Ln p� In .� W >C Q � � � � rn � a w H Z 00 a CD 00 x r hCIA qj qp T-4 Q - .A� 4- o a = 00 M H ° 3 O A GON vs y a '0t 0 ` W O W sn d. x Gp d o o Qy = ik co14 000 p 04% C� O v� I~ 00 cncy d ,�, [[�� ° C� •t1 � �cy � G O W z o O o O pq U Q c°a o V CF 0 � a cn y a114 .' � v tu - — CIE V E BUILDING DEPARI'MENT OCT 16 2023 VILLAGE OF Ry9,,BiO0K 938 KING Srt EEi,RvE BR[)fiK,NY 10573 VILLAGE OF RYE BROOK (914)939-0b68 BUILDING DEPARTMENT ww .r vebro k:or Application for Permit to Remove, Abandon and/or Install Fuel Storaze Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USF ONLY: 1 g O PL: .M Rff �: OCT 3 70 06 Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERmi,r& CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 5. 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, 10/12/2023 ,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 Tyne: Installation(/j•Removal(/fj •Abandonment( )/Abole G.rQund WBuried 'n Grottnd (1� h Yak} �kY►1dVd l I. Address: 100 Brush Hollow Close, Rye Brook gBL: 129.84-2-89 Zone: Lf1 2. Property Owner&Address: James Glucksman, 100 Brush Hollow Close, Rye Brook, NY 10573 Phone#: 914-934-9633 Cell#: 914-482-4033 email:jbglucksman _yahoo.Com 3. Contractor&Address: Phone#:914-919-3507 (Kelly) Cell#:914-327-1310 Dan Lee email: burkepermitsO-meenanlp.com 4. Applicant: Burke Energy/Kelly Redlon - Phone#: (914)919-3507 Cell#: 14 27-1 10 email:burkepermits@meenanip.com 5. Indicate Fuel Type: Fuel Oil(X)•L.P.Gas( ) •Gasoline( )•Other( ): 6. Number and Capacity of each Tank: Remove (1) 550 underground oil tank Install (1)275 gallon aboveground oil tank 7. Exact Location(s)of each Tank: (1) 550 UG oil tank-located at left rear of house (1)275 AG oil tank with cover-to be located outside on left side of house on concrete pad t 8/12/202 l OF E YO c0[TVT OF W85TCI4ESTBR ) as: being duly swom,deposes and states that he/she is the applicant above named, (grant nam of individuals i ing as the appiic Afusta es 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 a (indicate architect,coattaetor,agora,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 1 Zth _ Sworn to before me this day of Octob �26 23 day of Q C,20_�� X attire of Property Owner Sign re=,,, x J mes B. Glucksma€1 'rint mof Property Owner Print Nart Jonathan S.Pasternak NOTAYYPUBLIC,STATE OF NEWYORg N;-tilr) Public Rgistrativn No.02PA496778t Notary Public ELIZABETH SARLES Qualifiiedin Westchester County NOTARY PUBLIC,STATE OF NEW YORK Commission Expires Nov.10,2026 Registration No. 01 SA6392045 This application must be properly completed in its entirety and must inclt!de t e ioua=Y in Putnam County signatures) of the legal owner(s)of the subject property,and the applicant of Gto- Is s May 20,2027 provided, Any application not properly completed in its entirely and/or not properly signed shalt be deemed null and void and will be rsturned to 111C applicant. 2 8/12/2021 The Arbors Homeowners' Association 173 %2 Ivy Hill Crescent Rye Brook, NY 10573 September 22 2023 D James Glucksman OCT 19 2023 Linda Glucksman 100 Brush Hollow Close VILLAGE OF RYE BROOK Rye Brook, NY 10573 BUILDING DEPARTMENT Re: Above Ground Oil Tank Dear James and Linda, The Architecture and Grounds Committee (A&G) and the Board has reviewed your application for the above-named work. The approval requires that you screen off the tank with Giant Arborvitaes measuring at least five foot tall. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager [D F=NOV - VILLAGE O YF R BROOK BUILDING DEPARTMENT �noVQ,� U S�- t I 1— ok ow r Ul ffl DE `ir�j3 ; ENOV 672023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT c� :5 Ell s L 3 � 1 v �3y �I�va,;►�eS �yC� ��(� �c�S 1 i�� ,f � j � �r r•r i�,f a w a _ - s I p�O Double-wall Heating Oil Storage Tanks ' -- _- Utilizing double-wall construction for ultimate safety and reliability for all your home heating needs. i I: i Livingfull / energy Unique double-walled construction PC3+fl Our uniquely designed oil tanks are the safest and most reliable on the market.The outer tank is made of leak-proof,weld-free galvanized steel and rollseamed with an oil and fire-resistant seat. It can contain at least 110 percent of the capacity of the inner tank for maximum protection.The inner tank is made of blow-molded, high-density, seamless polyethylene that is leak proof and will never corrode. Roth tanks are easier and faster to fill thanks to their unique expansion system,all but eliminating the possibility of spills by home heating oil professionals. And, our compact tanks are available in several different sizes, providing more flexibility for placement in any home. Built with safety and the environment in mind Roth oil tanks exceed the industry standard safety regulations.They are rust resistant inside and out and are designed to prevent spills, leaks and fires caused by defective pipes,couplings or fittings located underneath the tank. In fact,it is the only tank on the market with no fittings below the oil line. Each tank undergoes thorough testing,including ultra-sound and pressure testing,to ensure optimal thickness and sealing. Roth DWT Features ' 1 Weld-free galvanized steel outer tank that can hold 110 percent of the primary tank 5 2 Seamless high-density polyethylene inner tank 3 Highly visible optical leak alarm 6 s 4 Up to 50 percent lighter than a 12-gauge steel tank with larger storage capacity 2 5 Non-corrosive steel filling system that provides an even level in each tank when installed in groups 1 _ 6 Burner feeding system with a duplex bushing installed directly into the �— 1 opening. Available with 3/8"or 1/2"slip-thru compression fittings for copper tubing. Fittings can be removed for a threaded opening of either 3/8" or 1/2". \ 7 Cover for outside use 1 r_j 4 n C us `NA- OIL NEAT Acvx unoN N GREAT CONSUMER WEBSITE FREE INSTALLATION TRAINING In an u effort1 help consumers become offer free, 1 2 hourinstallation more aware1the safety andreliabilitytrainingsessionson a regularbasis. Roth oiltanksoffer, designed Additionally, you have multiple microwebsitespecificallyfor this trainees,we are available1 provide 1roduct.It isloaded with valuableyour location. 1learn more information 1canbe found at 1session, your ...............,...�r,..a.,.,.........- 1 1 1representativeor aRoth Auk .....�.....- .....w...-..w-e...... wholesaler 1 Key Benefits Dimensions • Leak-proof and will not corrode Tank Model D • Outer tank holds 110 percent of inner tank for maximum protection Nom.capacity US gal(liters) 110(400) 165(620) 00) 275(loon) 400(1500) • Up to 50 percent lighter than Length inches(cm) 29(74) 29(74) 43(110) 51(130) 64(163) conventional steel tanks Width inches(cm) 28(72) 28(72) 28(72) 30(76) 30(77) • Can use for heating oil,diesel and Height inches(cm) 44(112) 61(155) 61(155) 54(137) 68(173) bio fuels,motor oil,DEF and ATF Min.height required inches(cm) 49(125) 1 66(168) 1 66(168) 1 60(152) 1 76(193) • Compact,economical design Tank weight lbs.(kg) 106(48) 132(60) 167(76) 208(94) 333(151) (8 sq.ft.for 1000L) Shipping weight tbs.(kg) 115(52) 143(65) 185(84) 230(104) 358(162) • Provides maximum storage safety with minimum space requirements • Removable base facilitates access to Tank tight spaces and greater stability Model •L 620L 1000L 100OLH 1500L • Wide handles on each end allow you 2 tanks in inches 29 x 60 29 x 60 43 x 60 51 x 63 64 x 63 to transport and handle with ease (side by side) (74 x 152) (74 x 152) (110 x 152) (130 x 160) (163 x 160) • Quality control and testing exceeds 3 tanks in inches 29 x 92 29 x 92 43 x 92 51 x 96 64 x 96 industry standards (side by side) (74 x 234) (74 x 234) (110 x 234) (130 x 244) (163 x 244) 4 tanks in inches 29 x 124 29 x 124 43 x 124 51 x 129 N/A (side by side) (74 x 315) (74 x 315) (110 x 315) (130 x 328) 5 tanks in inches 29 x 156 29 x 156 43 x 156 51 x 162 N/A (side by side) (74 x 397) (74 x 397) (110 x 397) (130 x 411) 2 tanks in inches N/A N/A 28 x 90 N/A N/A (end to end) (72 x 229) All double-walled tanks come with a generous 30-year Rest easy knowing Roth i limited warranty, as well as an insurance policy worth energyup to $2 million. reliable,are safe, durablemost r" market and they are - guaranteed i 1 ROTH OWT ACCESSORIES Roth provides the additional components you'll need to install and operate our oil tanks to their full 0 potential. N y.t,ao -Fuel Oil Gauge -Tank Cover(for outdoor installation) �-0 . BurkeEnergy Your local home service experts. Village of Rye Brook Building Department 938 King Street Rye Brook,NY 10573 475 CUrnrilerce Street December 21, 2023 Hawthorne,NY 10532 914.769.5050 T 914.769.1521 F RE: GLUCKSMAN /4224739 burkeenergy.com 100 Brush Hollow Close Rye Brook,NY 10573 Permit# MP 23-154 / Oil Tank Installation Close Out Letter November 9,2023 - Burke Energy/New England Environmental removed existing(1) 550 gallon underground tank from the rear yard and installed (1) Roth 275 gallon aboveground exterior oil tank with cover on a cement pad on the rear left side of the house. We installed new fill,vent,vent alarm,tank gauge,new oil line to boiler,shut off valve,tiger loop,and all necessary pipe and fittings to complete new installation. The new oil tank was installed in accordance with all existing local and state building department codes and ordinances. The old oil tank was removed and inspected and found to have no visible leaks. The tank was cut and cleaned on site and disposed of at a recycling center,scrap manifest provided. A soil sample was taken and sent to Phoenix Environmental Laboratories, Inc. All work was done in accordance with the New York Department Environmental Conservation (DEC) guidelines and local codes. Enclosed are the soil sample results and the bill of lading for oil removed. The waste oil was disposed of at an approved waste oil recycling center,manifest provided. Please contact Kelly in our Permit Department at 914-919-3507 if you require any further information. Thank you, John Burns / Install Manager / Burke Energy 914-769-5050 !_burns(&meenanlp.com burkepermits@meenanlp.com Heating I A/C I Propane I Oil Tank Removal I Generators I Home Security&Automation Crown STANDARD COLLEC Petroleum ORDER FORM waste Services 2252 936 Route 6 Mahopac, NY 10541 845.803.8253 EPA#i NYR000246355 NAME DATE GENERATORILOCATION BILL TO NAME: I L- - NAME' J' ,.1 d— L) 0 ATT. ETA: ATT. ETA: ADDRESS: `!/-)r') 1 1 I 1 >t i - t J 1 aDDREss:4)o CITY: �/1 STATE:- 1 ZIP: STATE:�L CITY` i�G f J 1/ ZIP: �U ) PHONE PO: PHONE: TIME IN: �� TIME OUT: /a. I 'S DESIGNATED FACILITY NAME AND SITE ADDRESS U NAME: U WATERWORKS 1 77 STEWART AVE RECYCLE OIL COMPANY 11600 SOUTH 25TH ST. ADDRESS& NEWBURGH.NY 12550 1 84S.561.4111 �EASTON.PA 180421010.250.8747 EPA ID N: NYD956908005 PA0980537666 DESCRIPTION pTY UNIT PR LINE TOTAL CHARGE MY ACCOUNT FOR THIS USED OIL REMOVAL TRANSACTION UNLESS OTHERWISE INDICATED IN THE PAYMENT SECTION. ANTI-FREEZE REMOVAL INVOICES REFLECTING CHARGES ARE SUBJECT TO AN INTEREST RATE OILY WATER REMOVAL Ti OF THE LESSER OR 1-11276 PER SLUDGE OISIIOSAL J MONTH(18%PER ANNUM)OR THE MAXIMU HATE ALLOWED BY LAW ON VACUUM SERVICE ANY INVOICES THAT ARE NOT PAID WITHIN 30 DAYS IN THE EVENT OF VACUUM SERVICE HOURLY RATE DEFAULT CROWN PETROLEUM SHALL TRANSPORTATION BE ENTITLED TO RECOVER COSS OF COLLECTION,INCLUDING REASON- ABLE ATTORNEY'S FEES. INITIAL ` ~� i $ TIME IN wAE our •• • • '><J h1/ i - f��f�. if`, kwo ate, 1�04 1Na USr_D OIL,11011 REGULATED,Nor US DOT HAZARDOUS MATERIALS,NIA,NONE,NONE _ Tr G OILY WAMFI,NON REGULATED,NON R,C,R.A.NIA,NONE,NONE Tr G PUFHOLLUM C0111AtAINA1rD SLUDGE,NO REGULATED.NOT US 00111AZAIIUOUS MAIEMALS.NA/.NONE.NONE TT > ` CA (,MMIA11"NJWN114 NA)IAINY6114111 IIIAI III(1JAII IILM611ANIMIIUA'I1W11'C 11101(IIMIIrI1r1AR111111AYE 110111II4MAIl1,[EAAIIW(p,M 01111:InWSF I CERTIFY THAT MY TOTAL WASTE mu41100 uuwmlrWilli MAlnwllullaAAluN11AM11IXnunulln'nI1n9LOr.nlulA1rrrn11r11MAIlu4LP1(Iu(nA_alWAA=M%`VA5lEtwo(n S I REAMS ARE WITHIN ONE OF THE NN1FJJYI IAM)/AA UWFFI I.)IIWr 10,0111 f1111•IIr:1111*1117AI n11A 11AI17111 AWN I e In 11MILn11FY NII1101101111N1111114111LA111NWS t53101I ANY 11wNd 0.1/hIG.NIMY1l(DIIIU.CI NIIrAtln(AIIU(AIYINlI WAY1n Ul(n IOAInI N.IId III[MOCKWAIIIW11YIn'IIIEPIII(ILA1011 FOLLOWING CATEGORIES: 1 COWNAIH 11101 I IAJ.IISAMIA1E NA)UJIIII-Ar KAM IIAYr 1111'CAPACIIYNAI AIN AIJIIIIIIVI II AIAIf11MM III It NI M:CMYWA:(W1 If I M I AM'IX'AnLt IA1YS OTO 220 LBSIMIONTH, 1 NN111.(YAAll"Aft,10 11WIYUTAlLII'1,lIIY1(,I4(J NU tAI NIIY(XI IJni'051Off,IIIr WA41(I CII I I,(YI II•S 1KSI11•.Il Ill I , INITIALS: _ _ ou r-r 2unmlauWntwAnlcro( lulu(w LIlA11IN/llllu(!f IJOIIYWM111 1uu111 �L - 220LBSTO2,200LB&MONTH INITIALS:_ pinNifUtUVAC. _ _� 1 _ I _I— HILL, _ __ -_ � GREATER THAN 2,200 LBS/h10NTH / INITIALS: i CamScanner PAYMENT RECEIPT Brookfield Resource Manager-nent 100 Lamont Street Elmsford, NY 10523 91 4-592-5250 Receipt:1835636 Date: 121412023 ustomer:2104 Time: 1 •03 .25 PM IEW ENGLAND ENVIRONMENTAL 24 S RIVERSIDE AVE #305 CRUTON, NY 10520 ID Number: Weigh 1n:�214/2023 12 56,35 Ticket:1888725 P v„ operator:Romy C Weigh out: 1214/2023 1 03 24 P%1 All are n aound4 o_therwSe s .tom Commodity Gross Tare Net Price TOTAL $ —r Tanks - 2 2300,�CVU ---------------- ----- - ----- --------- -----------------`-----�---- Ticket Total: 13.38 No, of Ticketal EZCash Paid: $13 00 Payment Method:EZCa51i Round Amt: iS0 33a Total Paid: $13- PHOENIX . Environmental Laboratories. Inc. Monday, November 20, 2023 Attn: Jeff Haig New England Environmental Services, Inc 420 S Riverside Ave#305 Croton NY 10520 Project ID: GLUCKSMAN SDG ID: GCP50719 Sample ID#s: CP50719 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, AOL 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 Pagc 1 0l 11 O `N ACCp9D PHOEwXt-P'--w" q. �y°� Environmental Laboratories, Inc. Q 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 November 20, 2023 SDG I.D.: GCP50719 Project ID: GLUCKSMAN Client Id _ Lab Id Matrix (BASE CP50719 ';SOIL Page 2 o111 �N ACCO9 PHOEYIXKi�.�.;W,1' ° 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: Jeff Haig New England Environmental Services, Inc November 20, 2023 420 S Riverside Ave#305 Croton NY 10520 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 11/09/23 14:00 Location Code: NEESINC Received by: B 11/17/23 16:20 Rush Request: 24 Hour Analyzed by: see"By"below P.O.#. Laborato iy Data SDG ID: GCP50719 Phoenix ID: CP50719 Project ID: GLUCKSMAN Client ID: BASE RL/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 78 % 11/17/23 AC1 SW846%Solid Field Extraction Completed 11/09/23 SW5035A Volati les 1,1,1,2-Tetrachloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,1,1-Trichloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,1,2,2-Tetrachloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,1,2-Trichloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,1-Dichloroethane NO 19 ug/Kg 1 11/19/23 JLI SW82600 1,1-Dichloroethene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,1-Dichloropropene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2,3-Trichoorobenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2,3-Trichloropropane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2,4-Trichlorobenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2,4-Trimethylbenzene 42 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2-Dibromo-3-chloropropane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2-Dibromoethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2-Dichlorobenzene NO 19 ug/Kg 1 11/19/23 Al SW8260D 1,2-Dichloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,2-Dichloropropane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,3,5-Trimethylbenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,3-Dichlorobenzene NO 19 ug/Kg 1 11/19/23 JLl SW8260D 1,3-Dichloropropane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 1,4-Dichlorobenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 2,2-Dichloropropane NO 19 ug/Kg 1 11/19/23 JLI SW8260D 2-Chlorotoluene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 2-Hexanone NO 96 ug/Kg 1 11/19/23 JLI SW8260D Ver 1 Page 3 of 11 Project ID: GLUCKSMAN Phoenix I.D.: CP50719 Client ID: BASE RU Parameter Result PQL Units Dilution Date/Time By Reference 2-Isopropyltoluene NO 19 ug/Kg 1 11/19/23 JLI SW8260D 4-Chlorotoluene ND 19 ug/Kg 1 11/19/23 JLI SW8260D 4-Methyl-2-pentanone NO 96 ug/Kg 1 11/19/23 JLI SW8260D Acetone 290 S 96 ug/Kg 1 11/19/23 JLI SW8260D Acrylonitrile NO 39 ug/Kg 1 11/19/23 JLI SW8260D Benzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Bromobenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Bromochloromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Bromodichloromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Bromoform NO 19 ug/Kg 1 11/19/23 JLI SW8260D Bromomethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Carbon Disulfide NO 19 ug/Kg 1 11/19/23 JLI SW8260D Carbon tetrachloride NO 19 ug/Kg 1 11/19/23 JLI SW8260D Chlorobenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Chloroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Chloroform NO 19 ug/Kg 1 11/19/23 JLI SW8260D Chloromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D CIS-1,2-Dichloroethene NO 19 ug/Kg 1 11/19/23 JLI SW8260D cis-1,3-Dichloropropene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Dibromochloromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Dibromomethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Dichlorodifluoromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Ethylbenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Hexachlorobutadiene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Isopropylbenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D m&p-Xylene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Methyl Ethyl Ketone NO 96 ug/Kg 1 11/19/23 JLI SW8260D Methyl t-butyl ether(MTBE) NO 39 ug/Kg 1 11/19/23 JLI SW8260D Methylene chloride NO 39 ug/Kg 1 11/19/23 JLI SW8260D Naphthalene NO 19 ug/Kg 1 11/19/23 JLI SW8260D n-Butylbenzene 26 19 ug/Kg 1 11/19/23 JLI SW8260D n-Propylbenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D o-Xylene NO 19 ug/Kg 1 11/19/23 JLI SW8260D p-Isopropyltoluene NO 19 ug/Kg 1 11/19/23 JLI SW8260D sec-Butylbenzene 28 19 ug/Kg 1 11/19/23 JLI SW8260D Styrene NO 19 ug/Kg 1 11/19/23 JLI SW8260D tert-Butylbenzene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Tetrachloroethene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Tetrahydrofuran(THF) NO 39 ug/Kg 1 11/19/23 JLI SW8260D Toluene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Total Xylenes NO 19 ug/Kg 1 11/19/23 JLI SW8260D trans-1,2-Dichloroethene NO 19 ug/Kg 1 11/19/23 JLI SW8260D trans-1,3-Dichloropropene NO 19 ug/Kg 1 11/19/23 JLI SW8260D trans-1,4-dichloro-2-butene NO 39 ug/Kg 1 11/19/23 JLI SW8260D Trichloroethene NO 19 ug/Kg 1 11/19/23 JLI SW8260D Trichlorofluoromethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Trichlorotrifluoroethane NO 19 ug/Kg 1 11/19/23 JLI SW8260D Vinyl chloride NO 19 ug/Kg 1 11/19/23 JLI SW8260D QA/QC Surrogates Ver 1 Page 4 of 11 Project ID: GLUCKSMAN Phoenix I.D.: CP50719 Client ID: BASE RU Parameter Result PQL Units Dilution Daterfime By Reference % 1,2-dichlorobenzene-d4 94 % 1 11/19/23 JLI 70-130°% %Bromofluorobenzene 106 % 1 11/19/23 JLI 70-130% •Dibromofluoromethane 103 % 1 11/19/23 JLI 70-130% •Toluene-d8 89 % 1 11/19/23 JLI 70-130% 1=This parameter is not certified by the primary accrediting authority(NY NELAC)for this matrix. NY NELAC does not offer certification for all parameters at this time. RUPQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ,Limit of Quantitation) ND=Not Detected at RUPQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a%)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: All soils,solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. S-Laboratory solvent,contamination is possible. 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 November 20,2023 Reviewed and Released by:Rashmi Makol,Project Manager Ver 1 Page 5 of 11 ID `N ACCOR PHOEVX U Environmental Laboratories, Inc. 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 ¢ NY#11301 QA/QC Report Tel.(860)645-1102 November 20, 2023 QA/QC Data SDG I.D.: GCP50719 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits Limits QA/QC Batch 707050(ug/kg),QC Sample No:CP50793(CP50719) Volatiles- Soil (Low Level) 1,1,1,2-Tetrachloroethane ND 5.0 116 112 3.5 101 102 1.0 70-130 30 1,1.1-Trichloroethane ND 5.0 116 114 1.7 107 106 0.9 70-130 30 1,1,2,2-Tetrachloroethane ND 3.0 108 106 1.9 98 97 1.0 70-130 30 1,1,2-Trichloroethane ND 5.0 108 107 0.9 98 99 1.0 70-130 30 1,1-Dichloroethane ND 5.0 117 116 0.9 91 109 18.0 70-130 30 1,1-Dichloroethene ND 5.0 118 114 3.4 121 111 8.6 70-130 30 1,1-Dichloropropene ND 5.0 110 107 2.8 105 101 3.9 70-130 30 1,2,3-Trichlorobenzene ND 5.0 109 105 3.7 91 95 4.3 70-130 30 1,2,3-Trichloropropane ND 5.0 91 92 1.1 84 83 1.2 70-130 30 1,2,4-Trichlorobenzene ND 5.0 109 103 5.7 85 92 7.9 70-130 30 1,2,4-Trimethylbenzene ND 1.0 107 104 2.8 97 96 1.0 70-130 30 1,2-Dibromo-3-chloropropane ND 5.0 122 116 5.0 94 95 1.1 70-130 30 1,2-Dibromoethane ND 5.0 112 108 3.6 98 99 1.0 70-130 30 1,2-Dichlorobenzene ND 5.0 108 106 1.9 97 97 0.0 70-130 30 1,2-Dichloroethane ND 5.0 109 108 0.9 101 102 1.0 70-130 30 1,2-Dichloropropane ND 5.0 111 110 0.9 105 108 2.8 70-130 30 1,3,5-Trimethylbenzene ND 1.0 107 104 2.8 100 98 2.0 70-130 30 1,3-Dichlorobenzene ND 5.0 106 104 1.9 94 95 1.1 70-130 30 1,3-Dichloropropane ND 5.0 107 104 2.8 99 98 1.0 70-130 30 1,4-Dichlorobenzene ND 5.0 109 107 1.9 96 98 2.1 70-130 30 2,2-Dichloropropane ND 5.0 126 122 3.2 111 107 3.7 70-130 30 2-Chlorotoluene ND 5.0 112 109 2.7 83 102 20.5 70-130 30 2-Hexanone ND 25 102 99 3.0 84 83 1.2 70-130 30 2-Isopropyltoluene ND 5.0 111 109 1.8 106 102 3.8 70-130 30 4-Chlorotoluene ND 5.0 109 105 3.7 98 98 0.0 70-130 30 4-Methyl-2-pentanone ND 25 108 106 1.9 93 95 2.1 70-130 30 Acetone ND 10 98 96 2.1 93 87 6.7 70-130 30 Acrylonitrile ND 5.0 109 104 4.7 77 91 16.7 70-130 30 Benzene ND 1.0 106 105 0.9 102 101 1.0 70-130 30 Bromobenzene ND 5.0 109 107 1.9 99 100 1.0 70-130 30 Bromochloromethane ND 5.0 107 106 0.9 99 101 2.0 70-130 30 Bromodichloromethane ND 5.0 117 115 1.7 102 105 2.9 70-130 30 Bromoform ND 5.0 119 113 5.2 88 92 4.4 70-130 30 Bromomethane ND 5.0 121 117 3.4 116 111 4.4 70-130 30 Carbon Disulfide ND 5.0 119 115 3.4 119 111 7.0 70-130 30 Carbon tetrachloride ND 5.0 120 117 2.5 100 100 0.0 70-130 30 Chlorobenzene ND 5.0 110 106 3.7 102 102 0.0 70-130 30 Chloroethane ND 5.0 131 130 0.8 141 128 9.7 70-130 30 i.m Chloroform ND 5.0 108 107 0.9 102 103 1.0 70-130 30 Chloromethane ND 5.0 112 109 2.7 101 100 1.0 70-130 30 cis-1,2-Dichloroethene ND 5.0 108 110 1.8 102 105 2.9 70-130 30 Page 6 of 11 QA/QC Data SDG I.D.: GCP50719 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits Limits cis-1,3-Dichloropropene ND 5.0 121 120 0.8 105 109 3.7 70-130 30 Dibromochloromethane ND 3.0 122 117 4.2 100 102 2.0 70-130 30 Dibromomethane ND 5.0 113 110 2.7 100 102 2.0 70-130 30 Dichlorodifluoromethane ND 5.0 111 104 6.5 95 88 7.7 70-130 30 Ethylbenzene ND 1.0 109 105 3.7 102 99 3.0 70-130 30 Hexachlorobutadiene ND 5.0 109 104 4.7 99 97 2.0 70-130 30 Isopropylbenzene ND 1.0 110 108 1.8 105 99 5.9 70-130 30 m&p-Xylene ND 2.0 107 103 3.8 99 97 2.0 70-130 30 Methyl ethyl ketone ND 5.0 98 97 1.0 83 83 0.0 70-130 30 Methyl t-butyl ether(MTBE) ND 1.0 116 114 1.7 113 110 2.7 70-130 30 Methylene chloride ND 5.0 113 110 2.7 116 112 3.5 70-130 30 Naphthalene ND 5.0 111 108 2.7 88 87 1.1 70-130 30 n-Butylbenzene ND 1.0 115 108 6.3 96 95 1.0 70-130 30 n-Propylbenzene ND 1.0 108 107 0.9 101 98 3.0 70-130 30 o-Xylene ND 2.0 110 105 4.7 102 102 0.0 70-130 30 p-Isopropyltoluene ND 1.0 110 108 1.8 102 99 3.0 70-130 30 sec-Butylbenzene ND 1.0 108 104 3.8 100 96 4.1 70-130 30 Styrene ND 5.0 105 102 2.9 96 96 0.0 70-130 30 tert-Butylbenzene ND 1.0 109 107 1.9 105 102 2.9 70-130 30 Tetrachloroethene ND 5.0 111 108 2.7 102 102 0.0 70-130 30 Tetrahydrofuran(THF) ND 5.0 106 103 2.9 91 91 0.0 70-130 30 Toluene ND 1.0 108 106 1.9 102 101 1.0 70-130 30 trans-1,2-Dichloroethene ND 5.0 118 115 2.6 121 112 7.7 70-130 30 trans-1,3-Dichloropropene ND 5.0 124 122 1.6 104 107 2.8 70-130 30 trans-1,4-dichloro-2-butene ND 5.0 132 126 4.7 93 96 3.2 70-130 30 1 Tdchloroethene ND 5.0 107 105 1.9 102 100 2.0 70-130 30 Trichlorofluoromethane ND 5.0 122 119 2.5 119 110 7.9 70-130 30 Trichlorotrifluoroethane ND 5.0 118 111 6.1 118 109 7.9 70-130 30 Vinyl chloride ND 5.0 116 114 1.7 112 106 5.5 70-130 30 %1,2-dichlorobenzene-d4 95 % 101 101 0.0 100 101 1.0 70-130 30 %Bromofluorobenzene 100 % 102 102 0.0 102 101 1.0 70-130 30 •Dibromocuoromethane 108 % 100 101 1.0 100 102 2.0 70-130 30 •Toluene-d8 93 % 101 102 1.0 102 102 0.0 70-130 30 Comment: Additional 8260 criteria:10%of LCS/LCSD compounds can be outside of acceptance criteria as long as recovery is 40-160%,25-160%for Chloroethane-HL and Trichlorofluoromethane-HL. I=This parameter is outside laboratory LCS/LCSD specified recovery limits. m=This parameter is outside laboratory MS/MSD specified recovery limits. If there are any questions regarding this data,please call Phoenix Client Services at extension 200. RPD-Relative Percent Difference LCS-Laboratory Control Sample Ub- MSLCSD-Laboratory Control Sample Duplicate r"'-Matrix Spike MS Dup-Matrix Spike Duplicate Phyllis hiller, Laboratory Director NC-No Criteria Nove ber 20,2023 Intf-Interference Page 7 of 11 Monday,November20,2023 Sample Criteria Exceedances Report Criteria: None GCP50719-NEESINC State: NY RL Analysis SampNo Aoode Phoenix Analyle Criteria Result RL Criteria Criteria Units "'No Data to Display'•• Phoenix Laboratories does not assume responsibility for the data contained in this exceedance report It is provided as an additional tool to identify requested criteria exceedences All efforts are made to ensure the accuracy of the data(obtained from appropriate agencles) A lack of exceedence information does not necessarily suggest conformance to the criteria It is ultimately the site professional's responsibility to determine appropriate compliance. Pege a of l f �O `N ACCO.90R 0 Q PHOBT U Environmental Laboratories, Inc. NY#>>so� 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Comments November 20, 2023 SDG I.D.: GCP50719 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: VOA Narration CHEM1411/19/23-1: CP50719 The following Initial Calibration compounds did not meet RSD%criteria:Acetone 26%(20%),Chloroethane 30%(20%) The following Initial Calibration compounds did not meet maximum RSD%criteria:None. The following Continuing Calibration compounds did not meet%deviation criteria:Chloroethane 39%H(30%) The following Continuing Calibration compounds did not meet Maximum%deviation criteria:None. Up to eight compounds can be outside of ICAL%RSD criteria and up to sixteen compounds can be outside of CCAL%Dev criteria if less than 40%. Page 9 of 11 %N ACCp9p9y PHOE U ' Environmental Laboratories, Inc. ` NY#11301 587 East Middle Turnpike,P.O.Box 370,Manchester,CI'06045 Tel.(860)645-1102 Fax(860)645-0823 NY Temperature Narration November 20,2023 SDG I.D.: GCP50719 The samples in this delivery group were received at 1.2°C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 10 of 11 i CoobK IP CE No CHAJN OF CUSTODY RECORD —P w or PHO 587 Fast Midme Tumpke,P O_Box 370.Mancees�r,CT 06040 (u Far Environmental Laboratories, Inc.FA M Eai In!o®onw ixboa: Fm(860)645-0823 1 pnonn. Client Services (860) 845-8726 Emall' )dV n~, .phndmc wrn Customer Now England Environmental Seivicesjnc. Project Project P.O: Address: 420 S Rt—s.Ave,ktM Report to pR�rn,.enewrtnc nm TT"3ec6an M/ST by Grotto On Nudwm NV 10520 lnvolce to: iwaneM w-ndmc mm compieterd M1M Ql10TE f Some QLwf"". 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' �fll,{i ,.t.- .,cfsr:� ioi► ( r _ George g Latimer ) s Xs�t� James Maisanoifl <o») ,�- �' uN Westchester County Executive )L.Lt)l l(1 Director,Consumer Protection ;\ Department of Consumer Protection Home Improvement License MEENAN OIL CO., L.P. 'rbW BURKE HEAT - . 475 COMMERCE STREET HAWTHORNE,NY-1 0532 ' This license is issued in accordance with Article XYI of the Westchester County Consumer Protection Code and is valid only upon c�. �. Naga = presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. _ 4 " NOT FOR FEDERAL PURPOSES «.Qaw License Number F0 �o Date of Expiration - ` WC-13355-H02 ,�, 10/11/2024 » J` p ) a< ► ��lOhBsterCo�� is y �\ 'aA6o>► '�.j...T I;f.'s�;'"��% �._._ rn„�.," nx ��i «t+" • >v r �� '�,.�., !cY,r, � f..,��.��� % 1�sq-s�� .: r ,�„uo s �" Itr�4.'n I/i�4461C��Its/f,I' ,U1+�hl '�il�ti�l '�'P IVI��F p 11(If'! �dl/! alp• •,fir ��', �. - 111r > ti'a Qfi}� �'„�r•/(y�l ,{gyp p;�i��y{' �E; (IN�u�..l�, �r ��r�lw C ,gp{.gJ,��'��}gyp n;.�r +per��fit} .4��` � -. I�w R'F: �E► cu�is! �w •• ��^�tfi •• -lt�w�� •• T�Ww�1�ti€„ o+ I�iYc'[r �! 'H�iA� J/ w1i*$,. �5'�w� a •� az��'Q�a ��� �Q -.>�;�r �Q `� '�'�Q�'..: " qp�,�,�„ 4 , Q��:� G� y 6�� •. ",�` p p� �$,, �, ,✓`L"J.� a..�rysi. ,L!p v. .N r +rtiv,4 .tvj. _ J,� A��® DATE(MM/DD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 10/12/2023 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Max Gomes MARSH USA,L-C. NAME: 1166 Avenue of the Americas nHc N E 347-328 3107 a No): New York,NY 10036 E-MAIL omes marsh.com Attn:NewYork.certs@Marsh.com ADDRESS: max.9 INSURERS AFFORDING COVERAGE NAIC E CN101414839•PETRO-ACORD-23- INSURER A:National Union Fire Ins Co Pittsburgh PA 19445 INSURED MEENANOIL CO.,LP INSURER B:N/A N/A D/B/A BURKE HEAT AND BURKE FUEL OIL CO. INSURER C:N/A NIA 475 COMMERCE STREET INSURER D: HAWTHORNE,NY 10532 INSURER E: INSURER F: T COVERAGES CERTIFICATE NUMBER: NYC-011745459-01 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 ADDLTYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDPOLICY/YYYY MMI EFF DDY EXP LTR LIMITS A X COMMERCIAL GENERAL LIABILITY GL 7032451 10/01/2023 10/01/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE15- CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 500,000 X XCU MED EXP(Any one person) $ 10,000 X Contractual PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000.000 X POLICY[XI JPERd LOC PRODUCTS-COMP/oP AGG $ 2,W0,W0 OTHER SIR $ 1,0W'0W AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accdent UMBRELLALIAH F — $ B OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUE NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If 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) THE VILLAGE OF RYE BROOK is included as additional insured where required by written contract. CERTIFICATE HOLDER CANCELLATION THE VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD KR Workers' CERTIFICATE OF STATE Board Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Meenan Oil Co.,LP 845-782-8161 dba Burke Heat and Burke Fuel Oil Co. 475 Commerce Street 1c.NYS Unemployment Insurance Employer Registration Number of Hawthorne,NY 10532 Insured 8311425-2 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 11-3083408 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AIU Insurance Company 3b.Policy Number of Entity Listed in Box"l a" Village of Ryebrook 938 King Street WC 016440041 Ryebrook,NY 10573 3c.Policy effective period 10/01/2023 to 10/01/2024 3d.The Proprietor,Partners or Executive Officers are �✓ included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums 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 may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that 1 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: David McElroy (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 09/27/2023 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 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 (9-17) www.wcb.ny.gov Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, October 25, 2023 11:20 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 10/25/2023 11:19 To: VIL RYE BROOK PRIMARY Transmitted: 10/25/2023 11:19 00001 Ticket: 10253-001-154-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 100 To: Name: BRUSH HOLLOW CLOS Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY NearSt: BRUSH HOLLOW LN & BRUSH HOLLOW CLOSE Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 10/30/2023 Depth of excavation: 8 FEET Site dimensions: Length 10 Width 8 FEET Start Date and Time: 10/30/2023 07:00 Must Start By: 11/14/2023 ------------------------------------------------------------------------------ Contact Name: JEFF HAIG Company: NEW ENGLAND ENVIRONMENTAL SERVICES INC Addrl: 420 S RIVERSIDE AVE Addr2: # 305 City: CROTON State: NY Zip: 10520 Phone: 855-245-9990 Fax: Email:Jeff@newenglandinc.com Field Contact: JEFF HAIG Alt Phone: 855-245-9990 Email:Jeff@newenglandinc.com Working for: GLUCKSMAN ------------------------------------------------------------------------------ Comments: Lookup Type: ADDRESS ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR i