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HomeMy WebLinkAboutMP24-042 BRC�v4 �i4GI Vy W V O� 7. 198 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 May 13,2024 Bowman III LLC 111 Bowman Avenue Rye Brook,New York 10573 Re: 111 Bowman Avenue, Rye Brook,New York 10573 Parcel ID#: 141.27-1-8 As per the Certification letter from Enviroshield Inc. dated May 7, 2024, the removal of an underground oil tank under Mechanical Permit#24-042 issued on 3/26/2024 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to a a = N N = a ",Zt `� a C) �1 'C eq a M .. O o a � �jW y a a U i 0 O 3 + "o �' a w P4 o y v � w an W _ rlo o _ W > E� a Le) Z O �O ° � � @ _ : O � � A Z rl a W a _ Z Q w °° oo ' o44 HO � a � a d u o 04 Q v cV �O b 04 °' . Q m W = P-4 u v a 00 _ VJ P Q M y0 ° ~ a 04 O 00 0 (ra � "Z � b ° ~ ' GIen N.. W ao v ce A V G� U O oQ a W a as• V E00 0 v z zo °aa ^� (u W = o CA W O o z F Cl.` � U � ~ � v x O Q ram, ao HOwp y q o, z ►� o Cl. a w a w � � BUIQRVE MENT VILOOK MAR 2 6 2024 938 KIlN,a ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove or Abandon. Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT #: HAr-,)Z1— © y�-- Approval Date: Permit Fee: S / U Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 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 or Abandonment S 185.00 per Tank. 5.Dig Safely New York#(dial 811): I►6qz+ 6. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon 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 or abandoned in conformance with all applicable Village,County,State&Federal laws,codes, rules and regulations. Indicate Permit Type: Removal 0/)•Abandonment( )I Above Ground( )• Buried in Ground 1. Address: 11 ti L SBL: q11 t� 7-1- 4 Zone: © —c 2. Property Owner&Address- lit + t\1 1�..G%-j f , (L'l`r tY � Rl•-t . Phone#: "It4-`i 39 - '%4-`" Cell#: email: 3. Contractor&Address: Phone#: `�03 .3 --' 16"H Cell#: email: %47 4. Applicant: 4`►'•R�S�` "�-�'►�'. Phone#: `a�3 3`3� �-+t`r Cell#: email: 5. Indicate Fuel Type: Fuel Oil(-I'-L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: \- 1Oc bntlo^ tlnpLRcl�•�•i-nD 1 75 7. Exact Location(s)of each Tank: �y"'Z LoCP' '''``a— �- L t 2/21/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 c2 day of 1 - c,r ,20 day of-Mo rC h ,20 2L rj s-P'� ature of—PPr- rty Owner ignature of Applicant _arm�l -J(, 4-so oTobw n cJ ��r,�,' .,► -- Prin m °f Prop er Print Name of Applicant Z6 , Notary Public Notary Public SEAN LYTLE 1VOTARYPUBZ/C styCOMMI"10n Expires 4-,x-l7't,Ac'%Qs This application inust be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deetned nul! and void and will be returned to the applicant. SEAN LYTLE I NOTARYPUBLIC Illy Commission Expires Aug.31,2V-- z 10/30/2023 QyE BRC�v� ��• �9b2 �' 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 : I bVLO rn r-'.-) A V e-. DATE: 41 - 30 - Z O L PERMIT# 'MP 2 L' - Q y Z ISSUED: 3-2(,-L SECT: BLOCK: LOT: LOCATION: P c� OCCUPANCY: ❑ Violation Noted THE WORK IS... 6 I'�ASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n L ❑ Natural Gas ,2 Vol4 (-,—.LLO J 0 f (- ❑ L.P. Gas J &-0 C.— CIA- FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTIONSSU-Q L]r FINAL ��n i �� C W li.�Q C-Cly e- co S 0 ❑ OTHER ►*4 S Q I D /SS ", C �I ,+. Y 4 16 i` •fir .�, -�•�` " _ _ �, J- y�✓°J © o D IDJ Clean, Preserve...Protect MAY - 8 2024 Environmental Specialists S VILLAGE OF RYE BROOK BUILDING DEPARTMENT May 7, 2024 Mr. Dominic Falcone Service Manager Westmore Fuel 86 North Water Street Greenwich, CT 06830 Subject: Tank Removal,Anri130,2024 Bowman III LLC 111 Bowman Avenue Rye Brook, New York Dear Mr. Falcone: On April 30, 2024, Enviroshield staff completed the removal of one underground 1,000-gallon fuel oil tank located at the subject property. The former location of the tank and progression of the tank removal process is shown in Site Photographs enclosed with this letter. Prior to the removal of the tank, all remaining liquid, sludge sediment and rinse water were pumped and cleaned from the tank for disposal by Enviroshield, Inc., a State of New York licensed waste transporter at Safety-Kleen Systems, Inc., 120 Forbes Avenue, New Haven, Connecticut. Attached is a copy of the waste transport bill of lading. The top of the tank was exposed using an excavator and enough soil was removed from the excavation to pull the tank from the ground. The tank was thoroughly inspected for rust, cracks, holes, or other physical characteristics,which could have been cause for a fuel release. No evidence of a fuel release was observed. Soil samples obtained from the tank grave were screened using the Photo Ionization Detector (PID); the results of the field screening indicated no evidence of a fuel release. A soil sample was collected from the bottom of the excavation, in the area presumed to be most impacted, and submitted to a Complete Environmental Testing (CE"1), a State of New York certified environmental laboratory for analysis by STARS 8260 and 8270. Consistent with New York State— Department of Environmental Conservation (NYS-DEC) requirements, these are the required analyses for oil tank removal in New York State. As indicated in the attached Complete Environmental Testing (CET) report #24E0045, the reported results for the sample tested are below the laboratory detection limit for all the constituents tested;no petroleum was detected within the sample. CT Home Improvement Contractor HIC.0582591 —Westchester Home Improvement License WC-27310-H14 250 Moffitt Street, Stratford,CT 06615 (203) 380-5644 FAX(203) 378-8736 www.enviroshield.com- info@enviroshield.com Page 2 of 2 May 7,2024 Bowman III LLC 111 Bowman Avenue Rye Brook,New York The tank was transported, cleaned, and disposed of at P.C. Metals, Inc., 270 Central Avenue, Bridgeport, Connecticut in a manner consistent with industry standards and in compliance with all Local,State and Federal Codes and Regulations. Attached is Tank Disposal Ticket#558540. The tank grave was backfilled and brought to grade. Based on visual observations, PID field screening and laboratory analysis, Enviroshield found no indication of the tank system's failure. If you have any questions concerning any of this work, please do not hesitate to contact me at your earliest convenience at(203) 380-5644. Sincerely, Enviroshield Inc. La. C4J� d Bochicchio Senior Project Manager Enclosures cc: Village of Rye Brook Building Department via email Ipctersen(<�).ivcbroolc.or Permit#MP 24-042 i 5 Site Photographs Residence,Enviroshield 1,000-gallon Underground Tank Removal, Bowman Avenue, Rye Brook, „p Ail i Y� ITT •� y 1' r yYt i�'a 1 t~ice }_ 1• — ��r��` .h�.=�}- �w Photo 1 of i Location of • • • . tank.Visibte • •- Site Photographs Enviroshield 1,000-gallon Underground Tank Removal Residence, 111 Bowman Avenue, Rye Brook, New York OR an y Photo 2 of 4.Tank excavated,exposed and pumped out. ZA ' ,O Site Photographs Enviroshietd 1,000-gallon Underground Tank Removal Residence, 111 Bowman Avenue, Rye Brook, New York a' Ile i YJ r i�t Photo 3 of 4. Empty tank grave. Site Photographs Enviroshield 1,000-gallon Underground Tank Removal Residence, 111 Bowman Avenue, Rye Brook, New York f r �"�r_ '�-•;tip _ - •,.; ,�F a, n Photo 4 of 4. Former location of underground tank; backfilled and restored. Clean, Preserve...Protect Environmental Specialists f BILL OF LADING DESCRIPTION: Check applicable waste ID, NA1993) Fuel oil /diesel/waste oil _ (UN1203) Gasoline _ (UN1223) Kerosene Off-Specification commercial chemical product fuel (applicable in CT only) _ Waste, NON-RCRA, Liquid, N.O.S. (Oil/Water mix) Non-Haz, None (applicable in NY State) Water only (no fuel waste). Date: U 190 LZ q Total Quantity: // 0 gallons Generator Name: Li7Cs�/Y70li`� y-C// Site Address: / / 1 ✓�W A'I qc 17 /� U city: `1G /`,l'Cz State: Zip: 16S-�-3 Telephone: a b 3. s 3 _ ��Ile w.0 #: Generator/Agent for Signature: 4)-'&--� Transporter: Enviroshield, Inc., 250 Moffitt Street, Stratford, CT 06615 203- -5644 Connecticut: CT-HW-495; New York: CT-095; Westch er ounty NY: WC-27310-1-114; Connecticut H.I.C. 0582591 54---C� Driver Signature: Destination/Facil y: Tradebe Treatment and Recycling of Bridgeport, 50 Cross Street, Bridgeport,CT 06610 Safety-Kleen Systems, Inc., 120 Forbes Avenue, New Haven,CT 06512 Tradebe Treatment and Recycling Northeast, 136 Gracey Avenue,Meriden, CT 06451 Approval Code: (SEE BACK FOR HAZARD/SAFETY/RESPONSE DETAILS) F\Templates\Misc\Bill of Lading Liquid docx P.O.Box 1296. 250 Moffitt St., Stratford,CT 06615 (203)380-5644 (800)394-2268 FAX(203)378-8736 www.enviroshield.com info@cnviroshield.com enviroshield.com 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615It" Fax:(203)377-9952 e-mail:cetl@cetlabs.com C(T M11 MVIRONMMA[TISTINC.X Client: Mr.Richard Louis Enviroshield,Inc. P.O.Box 1296 Stratford,CT 06615 Analytical Report CET# 24EO045 � r Report Date:May 06,2024 Project:Bowman 111 LLC,Westmore Fuel Project Number: 111 Bowman Ave,Rye Brook,NY PO Number:30201 Connecticut Laboratory Certificate:PH 0116 New York NELAP Accreditation: 11982 Massachusetts Laboratory Certificate:M-CT903 Pennsylvania Laboratory Certificate:68-02927 e Rhode Island Laboratory Certificatc: 199 Page 1 of 12 CET#:24EO045 Project:Bowman I I I LLC,Westmore Fuel Project Number: I I I Bowman Ave,Rye Brook,NY SAMPLE SUMMARY The sample(s)were received at 1.7°C. This report contains analytical data associated with following samples only. Sample ID Laboratory 1D Vlatnx Collection Date/Time Receipt Date Tank Grave 24EO045-01 Soil 4/30/2024 13:30 05/01/2024 Analyte: Percent Solids(SM 2540 GI Analyst: GVF Matrix: Soil Date/Time Laboratory ID Client Sample 1D Result RL Units Dilution Bateb Prepared Analyzed Notes 24EO045-01 Tank Grave 98 1.0 % I BE40352 05/03/2024 05/06/2024 10:20 Complete Environmental Testing,Inc. 80 Lopes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•wm-w.cetlabs.com Page 2 of 12 CET#:24EO045 Project:Bowman 11 I LLC,Westmore Fuel Project Number: 1 I 1 Bowman Ave,Rye Brook,NY Client Sample ID Tank Grave Lab ID:24EO045-01 Semivolatile Organics Analyst: STP Method:EPA 8270D Matrix:Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Preparcd Analyzed Notes Naphthalene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Acenaphthylene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Acenaphthene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Fluorcnc ND 110 1 EPA 3545A BE40210 05/02/2024 05/032024 23:51 Phenanthrene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Anthracene ND 110 1 EPA 3545A BE40210 O3/02/2024 05/03/2024 23:51 Fluoranthene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Pyrcne ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Benzo[a]anthracene ND 110 1 EPA 3545A BE40210 05/02/2024 05/03/2024 23:51 Chrysene ND 110 1 EPA 3545A BE40210 05/022024 05/03/2024 23:51 Benzo[b]fluoranthene ND 110 1 EPA 3545A BE40210 05/022024 05/03/2024 23:51 Bcnzo[k]Fluoranthcnc ND 110 1 EPA 3545A BE40210 05/02/2024 05/032024 23:51 Benzo[a]pyrene ND 110 1 EPA 3545A BE40210 05/02/2024 05/032024 23:51 lndeno[1,2,3-cd]pyrene ND I10 1 EPA 3545A BE40210 05/022024 05/032024 23:51 Dibenz[a,h]anthracene ND 110 1 EPA 3545A BE40210 05/022024 05/032024 23:51 Bcnzo[g,h,i]perylcnc ND 110 1 EPA 3545A BE40210 05/022024 05/032024 23:51 Surrogate:Nitrobenzene-d5 52.7% 30-130 BE40210 05/022024 0510312024 23:51 Surrogate:2-Fluorobiphenyl 6T9% 30-130 BE40210 05/022024 0510312024 23:51 Surrogate:Terpheny1414 93.3% 30-130 BE40210 05/022024 0510312024 23:51 Volatile Organics Analyst: MH Method: EPA 8260C Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared .Analyzed Notes Methyl-t-Butyl Ether(MTBE) ND 5.2 1.85 EPA 5035A-L BE40403 05/04/2024 05'04/2024 16:06 Benzene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/04/2024 16:06 Toluene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/042024 16:06 Ethylbenzene ND 5.2 1.95 EPA 5035A-L BE40403 05/042024 05/042024 16:06 m+p Xylenes ND 10 1.95 EPA 5035A-L BE40403 05/04/2024 05/04/2024 16:06 o-Xylene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/042024 16:06 Isopropylbenzene ND 5.2 1.85 EPA 5035A-L BE4040-1 05/042024 05/04/2024 16:06 n-Propylbcnzenc ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/042024 16:06 1,3,5-Triniethylbenzene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/04/2024 16:06 ten-Butylbenzene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/04/2024 16:06 1,2,4-Trimethylbenzene ND 5.2 1.85 EPA 5035A-L BE40403 05/042024 05/042024 16:06 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.cotn Page 3 0f 12 CET N:24EO045 Project:Bowman I 1 I LLC,Westmore Fuel Project Number: 11 l Bowman Ave,Rye Brook,NY Client Sample ID Tank Grave Lab TD:24EO045-01 Volatile Organics Analyst: MH Method: EPA 8260C Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes sec-Butylbenzene ND 5.2 1.85 EPA 5035A-L BE40403 05/04/2024 05/04/2024 16:06 4-Isopropyltoluene ND 5.2 1.85 EPA 5035A-L BE40403 05/04/2024 05/04/2024 16:06 n-Butylbenzene ND 5.2 1.85 EPA 5035A-L BE40403 05/04/2024 05/04/2024 16:06 Naphthalene ND 10 1.85 EPA 5035A-L BE40403 05/04/2024 05/04/2024 16:06 Surrogate:1,2-Dichlomethane-d4 96.1% 70-130 BE40403 05/04/2024 0510412024 16:06 Surrogate:Toluene-d8 99.6% 70-130 BE40403 05/04/2024 0510412024 16:06 Surrogate:4-Br moJluombenzene 97.9% 70-130 BE40403 05/04/2024 0510412024 16:06 Complete Environmental Testing,Inc. 80 Lopes Dri,c,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-www.cetlabs.coin Page 4 of 12 CET N:24EO045 Project:Bowman l l l LLC,Westmore Fuel Project Number: 111 Bowman Ave,Rye Brook,NY QUALITY CONTROL SECTION Batch BE40210-EPA 8270D Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BE40210-BLKI) Prepared:5/2/2024 Analyzed:5/3/2024 Naphthalene ND 100 Accnaphlhylenc ND 100 Acenaphlhene ND 100 Fluorene ND 100 Phenanthrene ND 100 Anthracene ND 100 Fluoranthene ND 100 Pyrene ND 100 Benzo[a]anthracene ND 100 Chrysene ND 100 Benzo[b]fluoranthene ND 100 Benzo[k]fluoranthene ND 100 Benzo[a]pyrene ND 100 indeno[1,2,3-cd]pyrene ND 100 Dibenz[a,h]anthracene ND 100 Benzo(g,h,i]perylene ND 100 Sum,gate:Nit-ben_ene-d5 68.1 30-130 Surrogate:2-Fluorobiphetivl 87.6 30-130 Surrogate:Tarphettyl-d14 109 30-130 LCS(BE4021G-BS1) Prepared:5/2/2024 Analyzed:5/3/2024 Naphthalene 2350 100 4,000.000 58.7 40-140 Acenaphthylene 2920 100 4,000.000 73.1 40-140 Acenaphtheae 3000 100 4,000.000 75.0 40-140 Fluorene 3160 100 4,000.000 78.9 40-140 Phcnanthrene 3400 100 4,000.000 94.9 40-140 Anthraccnc 3310 100 4,000.000 82.8 40-140 Fluoranihene 3570 100 4,000.000 89.3 40-140 Pyrene 3590 100 4,000.000 89.8 40-140 Beozo[a]anthracene 3340 100 4,000.000 83.5 40-140 Chrysene 3450 100 4,000.000 86.2 40-MO Betzo[b]fluoranthene 3360 100 4,000.000 84.1 40-140 Bcnzo[k]fluoranthcnc 3390 100 4,000.000 84.8 40-140 Benzo[a]pyrene 3420 100 4,000.000 85.4 40-140 lndeao[1,2,3-cd]pyrene 3510 100 4,000.000 87.9 40-140 Dibenz[a,h]anthracene 3510 100 4,000.000 87.8 40-140 Benzo[g,W)perylene 3770 100 4,000.000 94.3 40-140 Surrogate:Nitroben_ene-d5 80.2 30-130 Sum,gate:2-Fhu-biphrn14 78,1 30-/3t) Surrogate:Terpheayl-d14 99.1 30-130 LCS Dup(BE40210-BSD1) Prepared:5/2i2024 Analyzed:5/3/2024 Naphthalene 2320 100 4,000.000 58.1 40-140 1.00 30 Acenaphthylene 2990 100 4,000.000 74.6 40-140 2.12 30 Acenaphthene 3020 100 4,000.000 75.5 40-140 0.621 30 Fluorene 3230 100 4,000.000 80.8 40-140 2.36 30 Phenanthrene 3460 100 4,000.000 96.4 40-140 1.73 30 AnOuacene 3420 100 4,000.000 85.4 40-140 3.15 30 Complete Environmental Testing,Inc. 80 Lupes Dri,,e,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 5 of 12 CET k:24EO045 Project:Bowman I I I LLC,Westmore Fuel Project Number: I I I Bowman Ave,Rye Brook,NY Result RL Spike Source %Rce RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes LCS Dup(BE40210-BSDI)-Continued Prepared:5/22024 Analyzed:5/32024 Fluoranthene 3680 100 4,000.000 92.1 40-140 3.01 30 Pyrene 3640 100 4,000.000 90.9 40-140 1.17 30 Benzo[alanthraccnc 3420 100 4,000.000 85.6 40-140 2.43 30 Chrysene 3440 100 4,000,000 85.9 40-140 0.377 30 Benzo[b]fluorantbene 3410 100 4,000.000 85.2 40-140 1.35 30 Benzo[k]fluoranthene 3640 100 4,000.000 91.0 40-140 7.13 30 Beazo[alpyrene 3550 100 4,000.000 88.8 40-140 3.90 30 Indeno[1,2,3-cdlpyrene 3640 100 4,000.000 91.1 40-140 3.60 30 Dibenz[a,h]anthraccnc 3540 100 4,000.000 88.5 40-140 0.710 30 Benzo[g,hJ]perylene 3720 100 4,000.000 93.1 40-140 1.32 30 Surrogate:Nhrobenzme-d5 780 30-130 Surrogate:2-Fhmrobiphenyl 82.1 30-130 Surrogate:Terphem)d-d/4 101 30-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetiabs.com Page 6 of 12 CET#:24EO045 Project:Bowman I I I LLC,Westmore Fuel Project Number: 1 I l Bowman Ave,Rye Brook,NY Batch BE40403-EPA 8260C Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BE40403-BLKI) Prepared:5/4/2024 Analyzed:5/4/2024 Mcthyl-t-Butyl Ether(MTBE) ND 2.5 Benzene N D 2.5 Toluene ND 2.5 Ethylbenzene ND 2.5 m+p Xylenes ND 5.0 o-Xylene ND 2.5 isopropylbenzcnc ND 2.5 n-Propylbenzene ND 2.5 1,3,5-Trimethylbenzene ND 2.5 tert-Butylbenzene ND 2.5 1,2,4-Trimethylbenzene ND 2.5 sec-Butylbenzene ND 2.5 4-1sopropyltoluene ND 2.5 a-Butylbenzene ND 2.5 Naphthalene ND 5.0 Sumgate:1.2-Dichluroethune-d4 94.8 70-130 Surrogate:Toluene-& 99.3 70-130 Surrogate:4-BromoJluorobenzene 106 70-130 LCS(BE40403-BSI) Prepared:5/4/2024 Analyzed:5/4/2024 Methyl-t-Butyl Ether(MTBE) 48.2 2.5 50.000 96.4 70-130 Benzene 57.5 2.5 50.000 115 70-130 Toluene 56.9 2.5 50.000 114 70-130 Ethylbenzene 54.1 2.5 50.000 108 70-130 m+p Xylenec 119 5.0 100.000 119 70-130 o-Xylene 57.6 2.5 50.000 115 70-130 Isopropylbenzene 59.3 2.5 50.000 119 70-130 n-Propylbenzene 58.4 2.5 50.000 117 70-130 1,3,5-Trimethylbenzene 57.3 2.5 50.000 115 70-130 tert-Butylbenzene 57.1 2.5 50.000 114 70-130 1,2,4-Trimethylbenzene 56.6 2.5 50.000 113 70-130 scc-Butylbenzene 58.2 2.5 50.000 116 70-130 4-isopropyltoluene 58.6 2.5 50.000 117 70- 130 n-Butylbenzene 57.1 2.5 50.000 114 70-130 Naphthalene 51.4 5.0 50.000 103 70-130 Surrogate.1,2-Dichloroerhane-d4 93.7 70-130 Surrogate:Toluene-d8 tot 70.130 Surrogate:4-Bromofluorobenzene 104 70.130 Complete Environmental Testing,Inc. 80 Lupes Dri,.e,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•ww w.cetlabs.com Page 7 of 1-2 -1 CET N:24E0045 Project:Bowman I I I LLC,Westmore Fuel Project Number: 1 I I Bowman Ave,Rye Brook,NY 80 Lupes Drive *FT Tel:(203)377-9984 Stratford,CT 06615 COMP111I INVI OWNIAI 1I811NUE Fax:(203)377-9952 email:cetI@cetlabs.com Quality Control Definitions and Abbreviations Internal Standard(IS) An Analyte added to each sample or sample extract. An internal standard is used to monitor retention time,calculate relative response,and quantify analyzes of interest. Surrogate Recovery The%recovery for non-target organic compounds that are spiked into all samples. Used to determine method performance. Continuing Calibration An analytical standard analyzed with each set of samples to verify initial calibration of the system. Batch Samples that are analyzed together with the same method,sequence and lot of reagents within the same time period. ND Not detected at or above the specified reporting limit. RL RL is the limit of detection for an analyte after any adjustment made for dilution or percent moisture. Dilution Multiplier added to detection levels(MDL)and/or sample results due to interferences and/or high concentration of target compounds. Duplicate Result from the duplicate analysis of a sample. Result Amount of analyte found in a sample. Spike Level Amount of analyte added to a sample Matrix Spike Result Amount of analyte found including amount that was spiked. Matrix Spike Dup Amount of analyte found in duplicate spikes including amount that was spike. Matrix Spike%Recovery %Recovery of spiked amount in sample. Matrix Spike Dup%Recovery %Recovery of spiked duplicate amount in sample. RPD Relative percent difference between Matrix Spike and Matrix Spike Duplicate. Blank Method Blank that has been taken through all steps of the analysis. LCS%Recovery Laboratory Control Sample percent recovery. The amount of analyte recovered from a fortified sample. Recovery Limits A range within which specified measurements results must fall to be compliant. CC Calibration Verification Flags: H- Recovery is above the control limits L- Recovery is below the control limits B- Compound detected in the Blank P- RPD of dual column results exceeds 40% #- Sample result too high for accurate spike recovery. Connecticut Laboratory Certification PH0116 New York NELAP Accreditation 11982 Massachussets Laboratory Certification M-CT903 Rhode Island Certification 199 Pennsylvania NELAP Accreditation 68-02927 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-wwtiv.cetlabs.com Page 8 of 12 CET 4:24EO045 Project: Bowman 1 I I LLC,Westmore Fuel Project Number: 11 I Bowman Ave,Rye Brook,NY All questions related to this report should be directed to David Ditta,Timothy Fusco,or Robert Blake at 203-377-9984. Sincerely, This technical report was reviewed by Jeffrey Smith IVJ44i a04� 4�, Y //6/Z David Ditta Project Manager Laboratory Director This report shall not be reproduced except in full,without the written approval of the laboratory Report Comments: Sample Result Flags: E-The result is estimated,above the calibration range. H-The surrogate recovery is above the control limits. L-The surrogate recovery is below the control limits. B-The compound was detected in the laboratory blank. P-The Relative Percent Difference(RPD)of dual column analyses exceeds 40%. D-The RPD between the sample and the sample duplicate is high. Sample Homogeneity may be a problem. +- The Surrogate was diluted out. 'C1-The Continuing Calibration did not meet method specifications and was biased low for this analyte. Increased uncertainty is associated with the reported value which is likely to be biased low. •C2-The Continuing Calibration did not meet method specifications and was biased high for this analyte. Increased uncertainty is associated with the reported value which is likely to be biased high. *Fl-The Laboratory Control Sample recovery is outside of control limits. Reported value for this analyte is likely to be biased on the low side. •F2-The Laboratory Control Sample recovery is outside of control limits. Reported value for this analyte is likely to be biased on the high side. 'I-Analyte exceeds method limits from second source standard in Initial Calibration Verification(ICV). No directional bias. All results met standard operating procedures unless indicated by a data qualifier next to a sample result,or a narration in the QC report. For Percent Solids,if any of the following prep methods(3050B,3540C,3545A,3550C,5035 and 9013A)were used for samples pertaining to this report,the percent solids procedure is within that prep method. Complete Environmental Testing is only responsible for the certified testing and is not directly responsible for the integrity of the sample before laboratory receipt. ND is None Detected at or above the specified reporting limit Reporting Limit(RL)is the limit of detection for an analyte after any adjustment made for dilution or percent moisture. All analyses were performed in house unless a Reference Laboratory is listed. Samples will be disposed of 30 days after the report date. Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•wKw.cetlabs.com Page 9 of 12 CET it:24EO045 Project:Bowman 111 LLC,Westmore Fuel Project Number: I I I Bowman Ave,Rye Brook,NY CERTIFICATIONS Certified Analyses included in this Report Analyte Certifications EPA 8260C in Soil Mcthyl-t-Butyl Ether(MTBE) CTNYPA Benzene CTNYPA Toluene CTNYPA Ethvlbenzene CTNYPA i"Xylenes CTNYPA o-Xylene CTNYPA Isopropylbenzene CT,NY,PA n-Propylbcnzcnc CTNYPA 1,3,5-Trimethylbenzene CTNYPA tert-Butylbemene CTNYPA 1,2,4-Trimethylbenzene CTNYPA sec-Butylbenzene CTNYPA 4-Isopropyltoluene CTNYPA a-Butylbenzene CTNYPA Naphthalene CTNYPA EPA 8270D in Soil Naphthalene CT.NY,PA Aceoaphihylene CTNYPA Accnaphthenc CTNYPA Fluorene CT.NY,PA Phenanthrene CTNYPA Anthntccne CTNYPA Fluoranthene CTNYPA Pyrene CTNYPA Benzo[a)anthmcene CTNYPA Chrysene CTNYPA Benzo[b]fluDmathene CT.NY,PA Benzo[kJfluoranihene CTNYPA Bcnzo[a]pyrcnc CTNYPA lndeno[1,2,3-cd]pyrene CTNYPA Dibenz[a,h]anthracene CTNYPA Benzo[&hJ)perylenc CTNYPA SM 2510 G in Soil Percent Solids CT Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•wH-v.cetlabs.com Page 10 of 12 CET#:24EO045 Project:Bowman I I LLC,WCStmOre Fuel Project Number. 111 Bowman Ave,Rye Brook,NY Complete Environmental Testing operates under the following certifications and accreditation. Code Description Number Expires CT Connecticut Public Health PH0116 09/30/2024 NY New York Certification(NELAC) 11982 04/01/2024 PA Pennsylvania DEP 68-02927 05/3/2024 Complete Environmental Testing,Inc. 30 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-www.cetlabs.com Page 11 of 12 0 31ON N 1NOO HO#1V101 o 47 9 ¢ N N a U- a ❑ C n O CL N l6 r p u., 0 c �= Q o ❑ 3 p c N a E a 0 n I/ J v y ¢ E d p Q Q ❑ a W 4 > a > a Y -�� z ❑1WOjq"❑lalftd A Plod = p j PalOS LL W Q a m umi Z b t' ZS N � yO G1 dial C a a v E ~ O dldS c s ;, Clto a �- . Q m 0 VJ o O Q O Ial 1 O cn U. d33010 5 L 'Ilad 4P011d El v 4CD Cl) H V J p cn o > o F- a V/ VaaF!9 v W U an d m > to saplol JOH V J a y UsaPlansad LL asv❑ xas❑ saadLL H S 3 N z `w w o f0 O HVc SVNd OLN Q hJ a C Z isn.i.a oLz9 U C auaBoleH 09z9 o $ D Z` °n w o m g' C1 c SOPLUaV09Z9 a� C3 rJ m o o E u m U lsn la 09Z9 Z '' a O HOC m ...wBaums c CD tea oajy1 f 4) v y° m a)j t� •AeC]OM1 Aad 1»aN > ' E v S U m W � .step swag � c o � a CD L. m d d c � �Si�3'u ��� L A C7 a $ W m O U W aaEE C al w w >, O E $ ? « a rnrn � � Y W q a ^�DL CJ A U E. Q W ca mca p co O 3 3Y NNE® O C O. U > d m `a t t F E CL cg fn m 2 N N W LL7 C Fa'� y v C3. Syr u� O Q n l (a cti z 1 E E c m = ' 2.y E n a �� 5 a d � v O cD g m W -- CD p > o W ° �' m m 0 W Z- o O arc N ma E> j Z U i uzi Z c O CL t0 w a 0 C � ►° a o � J f` c W Z z E o o 9 o — -- co CO a. UU (n m cc x U v ¢ i� CC a m Q . m 1111111111111111111111 SCALE PURCHASE TICKET P.C. Metals, Inc 270 Central Avenue Bridgeport, CT 06607 203-367-9328 Ticket: 558540 Weigh In: 05/02/2024 08:34 Customer: 1034 Weigh Out: 05/02/2024 08:38 ENVIRO SHIELD Bridgeport,CT Commodity Gross Tare Net Price TOTAL$ UNP TANK 1360 0 1360 /GT ...... . ............ ................ ..... ... .......................... .............._.... Buyer: 0 1 hereby certify that I have the right to possess and sell this scrap. This is a Bill of Sale to the above described scrap. I hereby acknowledge payment in full. Customer Signature Please do not lose this ticket. Ticket required for payment. xF�01- E cq 3 N N N w = N N _ WO. C F - U vjr)0-4 - �w W z a v a� as O q f � ►�I �/ a. o Au s o W bA W IT-I hcr) �l a tr3 O � o Z a c 7 a 4 0 U Fy O q �+ D O p C/1 Qa W � E � � $ Cy Q� Qxo °= oo A =i o � [ 000 N cc W ce � y C � cvi � of oo C� ��� v o o " " W M O w p (�q0 p Qj w u w Qr W u ;d SSW 042o o � F.y M c W f�l ►ter a a °� .o v :i ;> ii o Q O O �" z zo °a ab v W O 0 � � a V w QPm O 3 p ° 2 F w ono c)o F c N O o A 0w y a A aW. z ¢ 02 g cb UV— E- .� m . ° o vQi � o a BUILDINC;.DEPARTMENT VIILLA(C of RYE�I3ROOK MAR 2 6 2024 938 KING S'riz'F.F'r RYE BRi 6K NY 10573 I I ('I11� -Oy6t1 , VILLAGE Ori(YE RO01< wp;ry rook:ore BUILDHNG DEPAR i�F 11E Application for Permit to Remove or Abandon Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICL USE.ONLY: PI-RV(IT R: M�d / � Q 7 Approval Date: i Permit Fee: S. f Approval Signature: Other: Disapproved: (Pucs are non-refundable) **Rw+w#+##aw+++##+#+#a#+awa#w++++w##w+#+#+w+#wwww##w}www}+r#aw*#*#####ww#*a##Ra#wwa#*w**a####a#*++#+### DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT IIAS BEEN ISSUED Bl'TIIE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.414) RE..OUIRI:NIENTS FOR RELEASE OF PERMIT& CI,:ItTIFICATF.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 Bolder) 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 or Abandonment S 185.00 per Tank. 5. Dig Safcly New York 11(dial 81 1): 03.7-%4- 6. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements arc fulfilled. a***#ww#+##*waw##+#+#w#++#*+*#wwww}wwww}+*w#ww}}#w+}aw+}#w##+######++w##+}#+++++w*w}###*w*####*+#*#*** Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit to rcmo%-c or abandon 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 or abandoned in conformance kith all applicable Village,County,State&Federal laws,codes, rules and regulations. Indicate Permit'I'ypc: Removal W)•Abundonment( )/Above Ground( )• Bti rigid in Ground(yam 1. Address: SBU I ll a 7-1— Z.onc: ^0� —c 2. Property Owner&Address:_ \ l �.s•+.,,o,� t L C , k\\ 1�,o..►,r+... , Phone#: _Ccll n: email: 3. Contractor&Address: T�j•2,5�`•w�'��C (roVvA �T2tiUC , �croa^�o+� do Qlb►S Phunc u: Cell 1/: —_ email:mac% 4. Applicant: y\+.QaS�.E.t.17'� --- Phone#: `ae3 `3g� `J1`\'* Ccll a: _ _ email: 5. Indicate Fuel Type:Fuel Oil(-'1•L.P.Cias( )•Gasuline( 1.Other( ): 6. Numbcr and Capacity of each Tank: \- \Oo:. �o ••n u�o t24C��'� �^�-- 7. Lxact Locaiion(s)of each'I-ank: t ^C-�o"'L ty ��.�'^�S'` �'�- "� CG —�+L 3��4r►c� 1 r 2/21/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 beeffoore me this ( � Sworn to before me this o?X day of / tC,nCJ� 20 �c day of'Moy--C h ,20 -7L_ U. ature of Pra0erty Owner Yignaturc of Applicant —�t��z�l��� k �cs�t Tc>��tt► l�n"Lao Prin In f Prop _ Print Name of Applicant Notary Public Notary Public SEAN LYTLE A'OrI.RYPL'31 rC Ily Commission Exr:res 4-.kg P t;,,5lSQ s This applic :ion must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property,and the applicant of record in the spaces Provided. Aiiy application not properly completed in its entirety and/or not properly signed shall be deemed nul! and void and will be returned to the applicant. SEAN LYTLE NOTARYPL'BLIC Icy Cowlsslon Expires Aug.31,20" 2 10/30/2023 QyE BR(�k. w � '9a2 BUILDING DEPARTMENT ❑BBUILDING INSPECTOR b 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: I bOtAD rV\4� A V'e- DATE:_41 - 3O - ZOL`1 PERMIT# _M? 2- 9 - 04L, ISSUED:3-2(�-L SECT: BLOCK: LOT: C9 LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... 6- MASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 1mo C<'LL0 cJ (- ❑ L.P.Gas I3'�FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING n + . l- { ❑ CROSS CONNECTION i� 1 r V^�U`�-"`' 1 l L l� FINAL C,�n_ 1 I ❑ OTHER ���� fi �f. � �. .. �A:: . .; �#}. -4,1 i.� ?.. � ��'•Y •y. ik �^t1~'.�'ri'G,' t My � l;`I v ��♦1 r ��! v `��)�/�����°t`��i��t�v ,� �� ��'r Y � ,r4r,�.`c r C ► 11 ;�r tnty III1 r e �,, (1 11 y ;�Y ;tir,�I It y �` 11111,1�� : ! /�1• � � / AR ... . . . . . r_.iul.W_..: •..\r�S1N"<(S�y Nt Cj O CN ? Viac NAn e V 11n y ction L r < )> O rn LL Cr- £" w N c~n � . 0 7— Ecc _ - s a <4")A, Asik d , �'y ♦ice ►! V L 72 r L ` t 1�Lsi�'� 3f•� (t A)> :icy (jl'Ij /llld�lll; INIlr. $-. to ,11 /t14tr /1111 II,11..#, _� 11 11!'ii i��• n4 � A�: 1.�>.1 {Ef>)�`£ <��,'`�gw , "df� w �li/><`. 14f Ali/�•�<I�1�`rY��? S u"�,Y Tf! �,1*,1t"�' &i' !", -t i'4.^',,may`',, A' a: J� � •► 1 l.1J'�r � 'RL.i- ! � 4. °K!J' iit ^ ��3� 3\ ENVIINC-01 TLIVER OCHE �ka�R� CERTIFICATE OF LIABILITY INSURANCE DATE A E(MMI 02rc3) 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 CX.T.CT Vincent Falcigno Gowrie Group n°.N Est: lFA FAX Nol: 70 Essex Road (--/co-,—� — - — -- -- Westbrook,CT 06498 IDDRi�ss•vfalcigno@risk-strategies.com 1NSURER(5)AFFORDING_COVERA_E_ NAIL a, — - - SURER A:Nautilus Insurance__Company _ _ 17370 INSURED INsuRERB:Great Divide InSuraince_Company _ _ _ 25224 Enviroshield Inc.and E.G.Kost Rental,LLC INSURER C PO Box 1296 ___ 250 Moffltt Street INSURER D:_ Strafford,CT 06615 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMB 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 BF 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. _ TYPE OF INSURANCE ADDL 9UBR1 POLICY NUMBER 1111111111)POLICY EFF I.PO Y EXP LIMBS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE_—_. 1,000,000 CLAIMS-MADE X OCCUR ECP01521982-24 1211/2023 12/1/2024 DAMAGE TO RENTED 100,000 pREM(SES.(Ea occu. ftfs MEP ExP An ona _reon 5.000 PERSONAL d ADV INJURY- S 1'000,000 GENERAL AGC_aRI;cAT,— _ 2,000,000 I''G'E�NT AOGREGA LIMIT APPLIES PER: i — - 1.^11 POLK:Y OX5E� J7 L0C PR UPTS_COMPADP AGG 2.000,000 1OTHER. COMBINED SINGLE LIMIT Is 11000,000 B AUTOMOBILE LIABILITY (E131CgdOlfU—.—.__..__ .S .. -- ANY AUTO BAP1521979-24 1211/2023 121112024 BODILY INJURY tPer Pe $ OWNED '- SCHEDULED AUTOS ONLY YX AUOTNOOS ED PBRQDILY.INJUORY(Peir acddenllYS X AUTOS ONLY _i AUTOS ONLY ..[PeEa�tl.¢nt)AMAGE_....Y - X MCS-90 En4n Is A ! UMBRELLA LLAS X OCCUR EACH OCCURRENCE S 1,000,000 X EXCESS LIAB CLANS-MADE FFX 2036752 12 12H/2023 12MR024 AGGREGATE S 1,000,000 DED 1 X I RETENTIONS 10,000 PERB WORKERS COMPENSATION I X S A-.LUTE OE& __ AND EMPLOYERS'LIABILITY YWCA 1521980 23 12/1/2023 17J112024 1,000,000 ANY PROPR970RIPARTNERIF�fECUTIVE YIN _ ACC E.L EACH (QXNT,.�. _ OFFiCEWMEMBEREXCLUDED? NIA 1,000,DOO (Mandatory in NH) E.L.DISEASE_-_EA EMPLQY $ -- If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 71 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Village of Rye Brook is listed as Additional Insured for General Liability where required by written contract. CERTIFICATE HOLDER CANCEL ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE____ Village of Rye Brook . 938 King Street'Rye Brook.NY 10573, k+1 ( ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ���� �, `,\ „��. ��J� '��1 - ►`. STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (203)394-2268 Enviroshield,Inc. Post Office Box 1296 Ic.NYS Unemployment Insurance Employer Stratford,CT 06615 Registration Number of Insured Work Location of Insured(Only required ifcoverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 060319014 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Commerce&Industry Insurance Company 3b.Policy Number of entity listed in box"la" WCA 1521980 23 Village of Rye Brook 938 King Street 3c. Policy effective period Rye Brook,NY 10573 12/1/23 to 12/1/24 3d. The Proprietor,Partners or Executive Officers arc ■ 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 "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above certificate holder 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 maybe sent by regular mail) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Vincent M.Falcigno (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ���� 12/1512023 (Signature) (Date) Title: Managing Member Telephone Number of authorized representative or licensed agent of insurance carrier: (203)745-0078 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein,however, shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, April 15, 2024 4:22 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/15/2024 16:22 To: VIL RYE BROOK PRIMARY Transmitted: 04/15/2024 16:22 00002 Ticket: 04154-002-580-00 Type: Regular Previous Ticket: 03214-000-909-00 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 111 To: Name: BOWMAN AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: TANK REMOVAL IN REAR OF PROPERTY BETWEEN BUILDING AND ASPHALT PARKING : LOT NearSt: RYE RIDGE PLZ & S RIDGE ST Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: TANK REMOVAL Estimated Work Complete Date: 05/18/2024 Depth of excavation: 12 FEET Site dimensions: Length 12 FEET Width 12 FEET Start Date and Time: 04/18/2024 07:00 Must Start By: 05/02/2024 ------------------------------------------------------------------------------ Contact Name: LIZ OLAVARRIA Company: ENVIROSHIELD Addrl: PO BOX 1296 Addr2: City: STRATFORD State: CT Zip: 06615 Phone: 203-380-5644 Fax: Email: hz@enviroshield.com Field Contact: LENNY BOCHICCHIO Alt Phone: 800-394-2268 Email: len@enviroshield.com Working for: WESTMORE FUEL ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER 1 VIL RYE BROOK WESTCHESTER CTY SWR i Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, March 21, 2024 1:34 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/21/2024 13:33 To: VIL RYE BROOK PRIMARY Transmitted: 03/21/2024 13:33 00004 Ticket: 03214-000-909-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 111 To: Name: BOWMAN AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: TANK REMOVAL IN REAR OF PROPERTY BETWEEN BUILDING AND ASPHALT PARKING = LOT NearSt: RYE RIDGE PLZ & S RIDGE ST Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: TANK REMOVAL Estimated Work Complete Date: 03/26/2024 Depth of excavation: 12 FEET Site dimensions: Length 12 FEET Width 12 FEET Start Date and Time: 03/26/2024 07:00 Must Start By: 04/09/2024 ------------------------------------------------------------------------------ Contact Name: LIZ OLAVARRIA Company: ENVIROSHIELD Addrl: PO BOX 1296 Addr2: City: STRATFORD State: CT Zip: 06615 Phone: 203-380-5644 Fax: Email: liz@enviroshield.com Field Contact: LENNY BOCHICCHIO Alt Phone: 800-394-2268 Email: len@enviroshield.com Working for: WESTMORE FUEL ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER 1 VIL RYE BROOK WESTCHESTER CTY SWR z