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HomeMy WebLinkAboutMP24-073 DRn 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.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 25, 2024 James Comstock 1 Sylvan Road Rye Brook, New York 10573 Re: 1 Sylvan Road, Rye Brook,New York 10573 Parcel ID#: 135.44-1-4 As per the Certification letter from Enviroshield Inc dated July 8,2024,the removal of an underground oil tank under Mechanical Permit#24-073 issued on 6/11/2024 has been satisfactorily completed. Sincerely, Steven E'. Fews Building& Fire Inspector /to �E BRC�v� o`` tim 1. 1982 BUILDING DEPARTMENT ❑BBUILDING INSPECTOR RJASSISTANT 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 ST L CIA A DU L DATE: � 2- L PERMIT# i�rl 1' Z �"I ' O �3 ISSUED: ZY SECT: BLOCK: / LOT: r , LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [ 'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS Q''FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER c v, a. j10 0 Ln en Lr) Q 10, v ° 200 o Q = ■ Q n W LO c �:. -a oo co V W v J z 0 00 © C7 c°� v ° C u 1�1 �J r• ° o v ~J H a a M z U0 z °' a V1 'n v � 11 O H H M CN O uj o o. u _ r � ON 04 r"00 O a Q y p -p W � � V V V o a ■ G7 0. Ci R O v y v ` ,� U W O o o H CL� �., z . - v 4 O `0 a Q aav Q� �r a 1.4 4* X cn r � N _ -M C E ME $UILD � MENT ID VIL < OF RY OOK ���� 938 KLNG j ET RYE BR NY 10573 VILLAGE OF RYE BROOM 4 -0 BUILDING DEPARTMENT wV.20V Aulpfication for Permit to �iyo*31�el Stora a Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT #: /�( /!Q Q / —0 7 Approval Dater Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) *,rwxxxxxx,t,t,trxxxxxxx*�*,r,r r***,�*�����+*xxw*wwx,r,t,c***xxx,rx*xxxxxxxxwx*,tx*xxxxwxx**,a,rxxxxxxwwwwwww,xxxx**** 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 COINSTRUCTION WITH A MINIMUNI 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: Installation: S 185.00 per Tank. 5. Dig Safety New York# (dial 811): Cho SIA - 6. Inspection by Building Department for installation. 7. Submit all Manifests&Reports(if applicable,after work has been completed). 8.Certificate of Compliance will be provided when all requirements are fulfilled. xwwxx,twwwxw*xxxxxxxxxxx*xwxxxxxxx*,rxxxwxxw**+r*xxxxxxwxwww**,tx,►*xxxx*xxxxxxx*xxxxxx***xxxxxxxxxxrrxsr,rxxx Application dated,7:1�rA %-t•7-c�2-t-t is hereby made to the Building Inspector of the Village of Rye Brook for a permit to 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 installed in conformance with all applicable Village,County,State&Federal laws,codes,rules and regulations. *x:��rw*xxxxx:t****xxxx**x**twwxxxx*x***xxxx*xx,tx,rxxxxxt****,�***wx******ww*x***�exwxxwwx*xxxwxxx*xxwxxxxxx Indicate Permit T e: Above Ground ( )• Buried in Ground kzetoov-& 1. Address: ? SBL: LI Zone: 2. Property Owner&Address: rT\R Phone#: °3 �t - -ISQ`S Cell#: email• trLl�3�a� �'r��l�•C-�'s^ 3. Contractor&Address: En� 4 4S(,,,4. nC Phone#: �3 - 3&- - j 6-'"i Cell#: email: 4. Applicant: Phone#: Cell#: email: --ZXX 5. Indicate Fuel Type: Fuel Oil(-*f•L.P.Gas( )•Gasoline( 1.Other( ): 6. Number and Capacity of each Tank: I. - Sao gw41a„ e2 1tc -ctp.Llo� u.,oe2gco�.�D '`Try , 7. Exact Location(s)of each Tank: t 6/i/2024 STA E OF NEW YO C,COUNTY OF WESTCHESTER ) as: • _,being duly sworn,deposes and states that he/she is the applicant above named, (punt name of to 'vidual 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 DUS nit� for the legal owner and is duly authorized to snake 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 day of r 20 [ / day of Jurre- 20 _ S' ature of Property ner "g •lure of cant Prutt atN n ff Property Own kjo Public �IurycyaRuWic w o j>�l This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. JAMIE M. FIORDELISI Notary Public,State of Connecticut My Commission Expires 05131i2029 7 10/30/2023 i t -J fioyds �,,. `•� ooQ\ �c c+c,�c a JJMpV s i F }l f 3 4 Clean, Preserve...Protect �•�'O` Environmental Specialists July 8, 2024 Mr.Jim Comstock 1 Sylvan Road Rye Brook, NY 10573 �� u Subject: Tank Removal, June 26, 2024 Residence JU G - 8 2C24 1 Sylvan Road _ Rye Brook, Connecticut VILLAGE OF RYE BROOK BUILDING DEPARTMENT Dear Mr. Comstock: On June 26, 2024, Enviroshield staff completed the removal of one (1) 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 (CET), 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 #24F0808, 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 July 8,2024 Residence 1 Sylvan Road 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#564486. 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. Leonard Bochicchio Senior Project Manager Enclosures cc: Village of Rye Brook Building Department via email 4jetexti ni iL i)L ebroc>k.or Permit#MP 24-073 Site Photographs Enviroshield 1,000-gallon Underground Tank Removal Residence, 1 Sylvan Road, Rye Brook, New York v Photo 1 of 4. Location of underground 1,000-gallon tank.Visible fill pipe(white flagged). oi-�; � ."'{,�.�.k//�".♦fir _ rl '� 86 - -- Excavated . expose grave. Photo 4 of 4. Tankgrave backfiRed to grade and restored. OR, uw ...tom v•�`,� _r Clean, Preserve...Protect Environmental Specialists 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: 2-10 Total Quantity: gallons -a. Generator Name: �C Site Address: ( `J;/� ✓a4 19, nn 11,, City: M1 r Ol' State: Zip: (0413 Telephone: W.O #: I&e 4//� Generator/Agent for Signature: Transporter: Enviroshield, Inc., 250 Moitt Street, Stratford, CT 06615 203-380-5644 Connecticut: CT-HW-495; New York: CT-095; Westchester County NY: WC-27310-1-114; Connecticut H.I.C. 0582591 Driver Signature: Destination/Facility: 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 w«w.enviroshicld.com infutc�renviroshield.com 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615 Fax:(203)377-9952 e-mail:cetl@cettabs.com CCMPI111 INVIROWN11111511N0,Xi Client: Mr.Richard Louis Enviroshield, Inc. P.O.Box 1296 Stratford,CT 06615 Analytical Report CET# 24FO808 Report Date:July 05,2024 Project: Comstock, 1 Sylvan Road,Rye Brook,NY PO Number: 30504 P r� Connecticut Laboratory Certificate:PH 0116 New York NELAP Accreditation: 11982 Massachusetts Laboratory Certificate:M-CT903 Pennsylvania Laboratory Certificate:68-02927 e Rhode Island Laboratory Certificate: 199 Page 1 of 13 CET#:24FO808 Project:Comstock,1 Sylvan Road,Rye Brook,NY SAMPLE SUMMARY The sample(s)were received at 4.4°C. This report contains analytical data associated with following samples only. Sample ID Laboratory ID Matrix Collection Date/Time Receipt Date Tank Grave 24FO808-01 Soil 6/26/2024 13:00 06/28/2024 Analyte: Percent Solids ISM 2540 GI Analyst:REW Matrix: Soil Dcte,Timc Laboratory 1D Client Sample 1D Result RL Units Dilution Batch Prepared Analyzed Notes 24F0808-01 Tank Grave 94 1.0 I BF42847 06/28/2024 07/01/2024 09:45 Complete Environmental Testing,Inc. 30 Lupes Drive,Stratford.CT 06615•Tel:203-377-9984•Fax:203-377-9952•wwlv.cetlabs.com Page 2 of 13 CET 0:24FO808 Project:Comstock, I Sylvan Road,Rye Brook,NY Client Sample ID Tank Grave Lab fD: 24FO808-01 Semivolatile Organics Analyst: STP Method:EPA 8270E Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notcs Naphthalene ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Acenaphthylene ND 110 I EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Acenaphthene ND 110 1 EPA 3545A BCT40119 07/01/2024 07/02/2024 13:47 Fluorene ND Ito I EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Phcnantbrene ND 110 1 EPA 3545A BC40119 07/01/2024 07/02/2024 13:47 Anthracenc ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Fluoranthene ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Pyrene ND 110 1 EPA 3545A BG40119 07i01/2024 07/02/2024 13:47 Benzo[a]anthraccne ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Chryscnc ND 110 1 EPA 3545A BG40119 07/01/2024 07/021202413:47 Benzo[b]fluoranthene ND Ito I EPA 3545A BG40t19 07/01/2024 07/02/2024 13:47 Benzo[klfluoranthene ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Benzo[a]pyrene ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/202413.47 Indcno[1,2,3-cd]pyrcnc ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Dibenz[a,h]anthracene ND 110 1 EPA 3545A BG40119 07/01/2024 07/02/2024 13:47 Benzo[gh,i]perylene ND 110 1 EPA 3545A BG40119 07/01/2024 07i02/202413.47 Surrogate:Nitrobenzene-d5 45.3% 30-130 BG40119 07/01/2024 0710212024 13:47 Surrogate:2-Fluorobiphenyl 59.7% 30-130 BG40119 07/01/2024 0710212024 13:47 Surrogate:Ter phenvl-d 14 83.9% 30-130 BG40119 07/01/2024 0710212024 13:47 Volatile Organics Analyst:ACS Method:EPA 8260D Matrix: Soil Result RL Datc/Timc Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Methyl-t-Butyl Ether(MTBE) ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Benzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Toluene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Ethvibcnzcnc ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 m+p Xylenes ND to 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 o-Xylene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Isopropylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 n-Propylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 1,3,5-Trimethylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Complete Environmcntal Testing,hic. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 3 of 13 CET N:24F0808 Project:Comstock, 1 Sylvan Road,Rye Brook,NY Client Sample ID Tank Grave Lab ID:24FO808-01 Volatile Organics Analyst:ACS Method:EPA 8260D Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prcparcd Analyzed Notes tert-Burylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 1,2,4-Trimethylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 sec-Butylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 4-1sopropyltolucnc ND 5.0 IAR EPA5035A-L BG40237 07/02/2024 07/021202413:25 n-Butylbenzene ND 5.0 1.88 EPA 5035A-L BG40237 07/02/2024 07/02/2024 13:25 Naphthalene ND 10 1.88 EPA5035A-L BG40237 07/02/2024 07/02/2024 13:25 Surrogate:1,2-Dichioroethane-d4 97.0% 70-130 BG40237 07/02/2024 0710212024 13:25 Surrogate:Toluene-d8 99.1% 70-130 BG40237 07/02/2024 0710212024 13:15 Surrogate:4-Bromq luoroben_ene 104% 70-130 BG40237 07/02/2024 0710212024 13:25 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 4 of 13 CET#:24FO808 Project:Comstock,1 Sylvan Road,Rye Brook,NY QUALITY CONTROL SECTION Batch BG40119-EPA 8270E Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Rcsutr %Rec Limits RPD Limit Notes Blank(BG40119-BLKI) Prepared:7/l/2024 Analyzed:7/2/2024 Naphthalene ND 50 Accnaphthylcnc ND 50 Acenaphtheae ND 50 Fluorene ND 50 Phenanthrene ND 50 Anthracene ND 50 Fluoranthene ND 50 Pyrene ND 50 Benzo[alanthracene ND 50 Chrysene ND 50 Benzorb]fluoranthene ND 50 Benzo[klfluoranthene ND 50 Benzo[a]pyrene ND 50 Tndeno[1,2,3-cd]pyrene ND 50 Dibenz[a,h]anthracene ND 50 Benzo[g,h,i]pe,ylene ND 50 Sunngute:Arhmbencene-d3 57.2 3n-130 Surrogate:2-Fluorobipherrv( 71.3 30-130 Surrogate:Terpheny1-d14 80.8 30-130 LCS(BG40119-BS1) Prepared:7/1/2024 Analyzed:7/2/2024 Naphthalene 2320 100 4,000.000 58.0 40-140 Acenaphthylene 2490 100 4,000.000 62.2 40-140 Acenaphthene 2570 100 4,000.000 64.3 40-140 Fluorenc 2640 100 4,000.000 66.1 40-140 Phenanthrcnc 2770 100 4,000.000 69.3 40-140 Anthraccnc 2920 100 4,000.000 70.5 40-140 Fluoranthene 2840 100 4,000.000 71.0 40-140 Pyrene 2840 100 4,000.000 70.9 40-140 Beazo[a]anthracene 2780 100 4,000.000 69.6 40-140 Chrysene 2870 100 4,000.000 71.7 40-140 Benzo[b]fluoranthene 2900 I00 4,000.000 72.4 40-140 Bcnzo[k]fluoranthcnc 3110 100 4,000.000 77.9 40-140 Benzo[a]pyrene 2950 100 4,000.000 73.8 40-140 Indeno[1,2,3-cdlpyrene 2900 100 4,000,000 72.6 40-140 Dibeoz[a,h]anthracene 2830 100 4,000.000 70.7 40-140 Benzo[g,h,i]peryleae 2750 100 4,000.000 68.8 40-140 Surrogate-Mtrobenrene-d3 54 7 30-130 Surrogate:2-1-7uonrbiph—d 65 3 30-130 Surrogate,Terphenyl-d14 81.2 30-130 LCS Dup(BG40119-BSDI) Prepared:7/1/2024 Analyzed:7/2/2024 Naphthalene 2510 100 4,000.000 62.7 40-140 7.75 30 Acenaphthylene 2700 100 4,000.000 67.4 40-140 8.10 30 Acenaphthene 2740 100 4,000.000 68.6 40-140 6.47 30 Fluorene 2760 100 4.000.000 69.1 40-140 4.37 30 Phenanthrene 2780 100 4,000.000 69.6 40-140 0.481 30 Anthracene 2820 l00 4,000.000 70.5 40-140 0.105 30 Complete Environmcntal Testing,Inc. 80 Lupes Drive,Stratford.CT 06615•Tel:203-377-9984•Fax:203-377-9952•wNw.cetlabs.com Page 5 of 13 CET#:24FO808 Project:Comstock,1 Sylvan Road,Rye Brook,NY Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rcc Limits RPD Limit Notes LCS Dup(BG40119-BSDI)-Continued Prepared:7/l/2024 Analyzed:7/2,12024 Fluoranthene 2800 100 4,000.000 70.1 40-140 1.40 30 Pyreue 2790 100 4,000.000 69.8 40-140 1.67 30 Bcnzo[alanthraccnc 2750 100 4,000.000 68.8 40-140 1.09 30 Chrysene 2820 100 4,000.000 70.5 40-140 1.73 30 Benzo[b]fluoranthene 2810 100 4,000.000 70.3 40-140 2.87 30 Benzo[klfluoranthene 3040 100 4,000.000 76.0 40-140 2.43 30 Benzo[a]pyrene 2930 100 4,000.000 73.1 40-140 0.918 30 indeno[1,2,3-cdlpyrene 2860 100 4,000.000 71.4 40-140 1.66 30 Dibcnz[a,h]anthraccnc 2790 100 4,000.000 69.7 40-140 1.55 30 Benzo[g,h,i]perylene 2750 100 4,000.000 68.7 40-140 0.210 30 Surrogate:Nirrobe ene-dS 59.0 30-130 Surrogate:2-Fhtorobiphenc( 685 30-130 Surrogate:Terphenp1414 'R 4 30-130 Complete Envirortmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.coin Page 6 of 17371 CET H:24FO808 Project:Comstock, I Sylvan Road,Rye Brook,NY Batch BG40237-EPA 8260D Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BG40237-BLKI) Prepared:7/2/2024 Analyzed:7/2/2024 Mcthyl-t-Butyl Ether(MTBE) ND 2.5 Benzene ND 2.5 Toluene ND 2.5 Ethylbenzene ND 2.5 m+p Xylenes ND 5.0 o-Xylene ND 2.5 Tsopropylbcnzcnc ND 2.5 n-Propylbenzene ND 2.5 1,3,5-Trimethylbenzene ND 25 tert-Butylbenzene ND 2 5 1,2,4-Trimethylbenzene ND 25 sec-Butylbenzene ND 2.5 44sopropyholuene ND 2.5 n-Butylbenzene ND 25 Naphthalene ND 5.0 Surrogate.1.2-Dichloroethane-d4 84.8 70-130 Surrogate:Toluene-d8 95.5 70-130 Surrogate:4-Bromo/Ltorobenzene 97.' 70-130 LCS(BG40237-BSI) Prepared:7/2/2024 Analyzed:7/2i2024 Methyl-t-Butyl Ether(MTBE) 46.0 2.5 50.000 92.0 70-130 Benzene 50.0 2.5 50.000 99.9 70-130 Toluene 48.5 2.5 50.000 97.1 70-130 Ethylbenzene 47.8 2.5 50.000 95.6 70-130 m+p Xylenes 98.1 5.0 100.000 98.1 70-130 o-Xylene 49.9 2.5 50.000 99.7 70-130 isopropylbenzene 51.5 2.5 50.000 103 70-130 n-Propylbenzene 52.4 2.5 50.000 105 70-130 1,3,5-Trimethylbenzene 52.1 2.5 50.000 104 70-130 tert-Butylbenzene 53.9 2.5 50.000 108 70-130 1,2,4-Trimethylbenzene 51.3 2.5 50.000 103 70-130 scc-Butylbenzene 53.1 2.5 50.000 106 70-130 4-Tsopropyltoluenc 53.4 2.5 50.000 107 70-130 n-Butylbenzene 55.3 2.5 50.000 ill 70-130 Naphthalene 53.2 5.0 50.000 106 70-130 Sunogate:1,2-Viehb,methane-d4 946 70-130 Surrogate:Toluene-d8 96.1 70-130 Surrogate:4-BronroJluorobenzene 97 1 70-130 GCS Dup(BG40237-BSD1) Prepared:7/2/2024 Analyzed:7/2/2024 A4ethyl-t-Butyl Ether(MTBE) 48.5 2.5 50.000 97.0 70-130 5.25 30 Benzene 51.5 2.5 50.000 103 70-130 3.05 30 Toluene 50.6 2.5 50.000 101 70-130 4.10 30 Ethylbenzene 51.6 2.5 50.000 103 70-130 7.65 30 m+p Xylenes 103 5.0 100.000 103 70-130 5.02 30 o-Xylcnc 52.2 2.5 50.000 104 70-130 4.57 30 lsopropylbenzene 52.6 2.5 50.000 105 70-130 2.15 30 n-Propylbenzene 49.6 2.5 50.000 99.2 70-130 5.51 30 1,3,5-Trimethytbenzene 49.2 2.5 50.000 98.4 70-130 5.67 30 tert-Butylbenzene 51.4 2.5 50.000 103 70-130 4.52 30 1,2,4-Trimethylbenzenc 49-4 2.5 50.000 98.9 70-130 3.77 30 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tcl:203-377-9984•Fax:203-377-9952-waw.cetlabs.com Page 7 of 13 CET#:24FO808 Project:Comstock,1 Sylvan Road,Rye Brook,NY Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes LCS Dup(BG40237-BSDI)-Continued Prepared:7/2/2024 Analyzed:7/2/2024 sec-Butylbenzene 50.6 2.5 50.000 101 70-130 4.83 30 4-lsopropyltoluene 52.0 2.5 50.000 104 70-130 2.75 30 n-Butylbcnzcnc 52.4 2.5 50.000 105 70-130 5.46 30 Naphthalene 51.7 5.0 50.000 103 70-130 3.01 30 Surrogare:l.2-Dichloroerhane-d4 934 70-130 Surrogate:Toluene-& 98.9 70-130 Surrogate:4-8romu luoroben-ene 102 70-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-www.cetlabs.com Page 8 of 13 CET N:24F0808 Project:Comstock, I Sylvan Road,Rye Brook,NY T 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615 COMRIII INVIRONMINIAI HIM,ING Fax:(203)377-9952 email:cetl�yacetlabs.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 analytes 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% 4- 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 INELAP Accreditation 68-02927 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford.CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.cotn Page 9 of 1371 CET 9:24FO808 Project:Comstock, I Sylvan Road,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 Timothy Fusco 0. !i 0-� 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°/u. D-The RPD between the sample and the sample duplicate is high. Sample Homogeneity may be a problem. +- The Surrogate was diluted out. *Cl-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. *F1-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(unit 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,StratCord,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 10 of 13 CET d:24FO808 Project:Comstock, I Sylvan Road,Rye Brook,NY CERTIFICATIONS Certified Analyses included in this Report Analyte Certifications EPA 8260D in Soil Mcthyl-t-Butyl Ether(MTBE) CT,N)',PA Benzene CT,NY,PA Toluene CT.NY.P.A Ethylbenzene CT,NY,PA m+p Xylenes CT.NY,P.A o-Xylene CT.NY.P.A Isopropylbenzene CT.NY,PA n-Propylbenzcnc CT.NY,PA 1,3,5-Trimethylbenzene CT.NY,PA tert-Butylbenzene CT.NY,PA 1,2,4-Trimethylbenzene CT.NY.PA sec-Butylbenzene CT,N%'.P.A 4-Isepropyltoluene CT.NY,PA n-Butylbenzeae CT.NY,PA Naphthalene CT.N Y.PA EPA 8270E in Soil Naphthalene CT,NY,PA Acenaphthylene CT.NY,PA Acenaphthcnc CT.NY,PA Fluorene CT.NY.PA Phenawlarene CT.NY,PA Anthracenc CT,NY,PA Fluoranthene CT.NY,PA Pyrene CT.IN-Y,PA Benzola]anlhracene CT.N Y,PA Chrysene CT.NY,P.4 Benzo[blfluoranthene CT.NY.P.A Bcnzo[k]Buoramhene CT.NY,PA Benzolalpyrmc CT.NY,PA Indeno[] ,3-cd]pyrene Cr.NY,PA Dibenz[a,h]anthracene CT.NYTA Benzo[g,h,i]peryicne CT.NY,P.4 SM 2540 G in Soil Percent Solids CT Complete Enviroumental Testing.Inc. 80 Lupcs Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-www.cetlabs.com Page 11 of 13 CET#:24FO808 Project:Comstock, I Sylvan Road,Rye Brook,NY Complete Environmental Testing operates under the Following certifications and accreditations r Code Description Number Expires CT Connecticut Public Health PHO116 09/30/2024 NY Ncw York Certification(NELAC) 11982 04/012024 PA Pennsylvania DEP 68-02927 05/31/2024 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 12 of 13 3 M a 31ON 1NOO�O a 1VIM o S M co w Q w a c i ) ❑ a m oo u 0 3 Oy W i0 C: u, 'v ❑ a m Z N o ? a :o ECc m 0 Y �Q $ 0 ❑ W m � z y C, O u U ❑�ay1�ral ��al�Pati F` Ia Ti •!$ z W Pa^I�o F E a o o m `� � O as dn01 o E m ❑ } co a dldS N J c o o a Ie101 vi `cam -v r " •• ~.. O d33010 SL m a V m o .O- 'IWd AIPoPd El H rn > o (a7 vdOd a °c o r > �Pp aH w.0 COp d C! Cc >` U sappnsed 3 U ` co co V C) e co fn (L 3SV ClXOS 0 SaOd LY co In O HVd/sdNd 0LZ8 F a 7 N Milo OL39 a (� T m n � Z Hd.1310 c In m $ D r maxi Q -2601UH 09Z9 In w d m g ° n 9 C T synewaV 09Z9 O e S E m f° U Irr lO 09Z9 z a U o h¢ v ..1 N m r U m AB(3 amyl Wy Yo _ U ,AeQ OMl L� m 7 O > m Y .!eQ ycaN c-A tP h r ,Aed ewes i W n ` ZE Y gg Vi 7C � 30tJ�i t w N C� g Wm� m � m a n 0 p p N W �� EE 0 E C 8 >: - , U w C 7 Q 2 O) 3 cnc) L, L) UO z � — c a NN®n S Z is M \ dcn U 1 W w W r a � Za o cs E E m C n 0 E E d L) a 2 '� a u, CO z a �' p � (o y V) o a)o o w -, m m o C� > a C' D U d o ¢ w o w o m n oa _u > N w m eo o N z_ C7 ■®� I 4`p CO C W Q O O H a O fV �� d cn H > z C d C J cci c , LLt z — •� E c O l 0= O O w w Q $ d c° 10 — I ago cn a U cn � o✓� c U u a i5 Q a Q :9 • N i++ II SCALE PURCHASE TICKET P.C. Metals, Inc. 270 Central Avenue Bridgeport, CT 06607 203-367-9328 Ticket: 564486 Weigh In: 06/26/2024 14:39 Customer, 1034 Weigh Out: 06/26/2024 14:40 ENVIRO SHIELD Bridgeport, CT Commodity Gross Tare Net Price TOTAL$ UNP TANK 1100 0 1100 /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. ��O D9 I: BUILDING.DEPARTMENT J VILLAGE OF Rv'ESROOK JUN - 6 2Q24 938 Kim;STRFFT RYE BRUox,NY 10,573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT ��ww.r*t rnoknr•.�o� Application for Permit tp R6No✓&'fie1 Storage Tank ("Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR 011'I0: USF ONLY PIiR�IIT R: MPS o /' 3 Approval Datc: \\'�,�Z Permit Fcc: S Approval Signature: Other: Disapproved: (ices arc non-refundable) }*##***##*+*++++}+}+++}+++*}+r+##*++}+*#+##w#ww#w}*w}+##w#w#*##++*++##ww*#}+***##}###+++++#}#+}}}++++#* DO NOT S'1'.%K'1 N ORK or( ONSTRUC HON I N'1'11.,%11EI4Nll'l' II.%S BEEN ISSUED Rv TIIE BUILDING INSPECTOR.THE ADMINISTR,%ri%*E FEE FOR %%()RK PROGRESSED OR COM111-EYED WIT1101(1T 1 PERMIT IS 12%OF TIIF.TOTM,COST OF C'ON%TRIICTION %%ITH ,k %l1NINIt'%1 FEE OF S750.1111 RE0U1RFMFN I'S FOR RELEASE:OI: PE:RMIT&CE:RTIFICATE.OF C MPLIA.XCE: I.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 I or NY State Workers Compensation Waiver) 4. I:cc per Tank: Installation: S 185.00 per Tank. 5. Dig Safcly New York!!(dial K 11): C%bo'SIA 6. Inspection by Building Department for installation. 7.Submit all Manitests& Reports(if applicable,after work has been completed). 8.Certificate of Compliance will be provided when all requircmcnls are fulfilled. **#**#**#*#*###ww•ww#ww**}##ww#w#w}w+w*#w}w#+##}}#++*w}w*w}##*+*#w#r##*+*###+**+*w**#*++}**+*#*+#**#*# Application datcd.'Z'"A-%-T•7-J',2,t-(' is hereby made to the Building Inspector of the Village of Rye Brook for a permit to install a I:ucl Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s) will be installed in conformance with all applicable Village,County,Slate&I:cdcral laws,codes,rules and regulations. Indicate Permit TN pe: Above(:round ( )• Buricd in Ground t �'{�icgp►iq I. Address: 5t3L: ��i j— 4/4— --- Zone: 61 7 2. Property Owncr&Address: Phone u: aQ3 it - 1�305 _Cell u: entail: �S-Tzrett 35�. 3. Contractor&Address: Ens•Q �S In i4 '__ '� _ Phone#: "�3 360 -6tL" Cello: email: Tn�t C' Fi.'•QQShtt Ca r 4. Applicant a1t''•'R�1.t,i^ -� _ 1'holte#: 3 ' 3s`' -`- °`�`t Cell 0. _ _ email: —11" C S��•n-�+`�-',�'^^ 5. Indicate 1=ucl Type: I:uel Oil(-I'-L.P.Gas( )•Gasoline( )-Other( ):. _ 6. Number and Capacity of each Tank: _ 7. FractLocation(s)ofeachTank —1'1�� "tea-•�L lS LGe�� —1..� 'fi�L _ _�o`� LSe.�-i- pt- 'k�L �tS;,f��t...c� I 6/112024 STA E OF N+"'YQ COUNTY OF WESTCHESTER ) as: r/dQ l /k- e4, e being duly sworn,deposes and states that her she is the applicant dtiove named, (print name of inifividual signing is 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 W,-%_z __for the legal owner and is duly authorized to make and file this application.(indicate architect,comactur,agent,attorney,err.) 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 day of r--7 u c -'2t► 2. (-/ day of Ju/1e-- ,20 —- ature of Property ner / '-g cure of cant SitPrtnt am f Property Own Ab Public wr— op P"I This application must be properly compleled 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 entirely and/or not properly signed shall be deemed null and void and will be returned to the applicant. JAMIE M.FIORDEUSI Notary Public,ftle o/Conneacut My Cornmisak)n Expires 05/31/2029 M 30 2023 s n u`o E h W a � a s � u O > N W S u _ W C W W .w/ Cl. o a ... x O 1�1 � � c � 1 � u�., $ � 'd o � •a a �W" O wt � z c Qxo It� C ., � y u 00 7 Z M z Uz by ° v� eq ^ u 41 .4 A z ', N U A as A 0 0 r� m o ;D 0 g � w 0 v � ✓ v x v w o z w �' H ogygo 'O .. Q 0. 4 a n. U o W o a " t �il M 04 041 114 vim, 9 .810, _ r\ .c .� 'thy` �" ��•r• _ fir- iy,.\wr � �A ,���'Cygt"�, `. lic 'C• v c,^ 4.. 'T v ,f v r,f1 .f.i ' ! \{w 7�t, 4�rm .N'�t <(o)'>s'..d-`�y1Np ��-�,�I�rl•1' -:=r, yr1��l�i'�_�:�;�`.�'::�'i•�I�ii'+-.��:Mi y�r,��11�'r � �`,�,�11}��1�� �,�>����``), I�+i ��'- ��..• .:s � 0 � =y' 1 > C N_ u CN D Hcc .140 Alt Ik a1 QI •ur In W cD . W cfl o :C asm—) z o�ection ry a ON LL cr ., L VA . Ono ca o 4. L ti N w: 1 L � . ;r _ .;•.;�w,�: � { .,fit«cs)>� - <(•G�)> _'',,,1/A•'-42f +�i•:,r,— Ir•�-h `•_/—�,� eke f, ,+1 fl K +*�. j r�� ��-r --,�r�c-- - -- -•�' �! «O)D� wl •r�• A �/ yat!', � ;p i► ♦.. �TA4�' L � A\�%� `G.<1• .��RA`i�3: !i<�i 3���7Ar !!�+1<1<111�r. jZ�g�A�1°#�,' �v 'G •ri+� ..�0.\ •'1i1'.54�''a �e� "k .,�'�1N .•O /�'1.k4 O;• ��+f, V•`�7 �fY yN /i'� (Q* -� ENVIINC-01 TLIVERNOCHE .�►CORO' CERTIFICATE OF LIABILITY INSURANCE DATEiMM/DDI1'YYYj �i 12/5/2023 f 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 III). CONTACT Vincent Fakigno PRODUCER _NAME. Gowrie Group jacNo,Eaq: 70 Essex Road EMAIL V�aki n,,p�risk-strafe ies com Westbrook,CT 06498 ADDRESS:�__s!Qr _ .. g._...r INSURER(31 AFF0R0046 COVES INSURER A:NaUtilU8Lins_ -tnCe C011l�il� INSURED INSURER e-9reat Divide insurance Comparry __.�25224 Enviroshield Inc.and E.G.Kost Rental,LLC INSURER C __— PO Box 1296 250 Moffitt Street INSURER 0: Stratford,CT 06615 INs~A: INSURER F: COVERAGES CERTIFICATE NUMBER: 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- AOOL iUeM, /OLICY EfFT_'OLILV E7IP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LUIBILITY I EACH OCCURRENCE 1,000,000 CLAMS-HARE X OCCUR �ECPO`1521982-24 12/1f2029 12/1/2024 DAMAGE TO RENTED 1QQ�000 PREMISES(Ea occurrence)MED EXP(Any one persona_ 5,000 1,000,000 PERSONAL ADV WJURY_ GEN'L A TE LIMIT APPLIES PER: GENERALAGCREGATE 2,0�,ODQ � PRODUCPOLICYXXXXXJEp T L A_COMP/OP A 2,000,000 OTHER- — COMBINED SINGLE LIMIT 1,0N.000 B AUTOMOBILE UABRnY (Ea accident) —_— S —_ -___ ANY AUTO BAP1511979-24 121112023 12/1/2024 BODILY INJURY_(___ - _- OWNED SCHEDULED i AUgT�OS ONLY X AUTOpSW p BODILY INJURY(Pet.. __ _ .._ X AUTOS ONLY X AUOTOS ONLYe�ac donlpAMAGE X i MCS-90 F_nd't S A �.-�UMBRELLALIAB X JCCUR EACH OCCURRENCE S 1,000,000 X I EXCESSL CLAIMS-MADE FFX203675212 121112023 1211/2024 AGGREGATE 5 1'000'000 IAB �DED 'X RETENTIONS 10,000' B WORKERS COMPENSATION XX� e .1__.CK_AND EMPLOYERS'LIABILITY YIN CA 1521980 23 121112023 12/1/2024 1,000,000 AFFICERlM MBER EXCLUDED?ECUTIVE I NIA EACH - - L 1,000,000 (Mandatory rn NH) If yes,cesr ibe under I 1,000,000 DESCRIPTION OF OPERATIONS bebw __ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) Village of Rye Brook is listed as Additional Insured for General Liability where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Village of Rye Brook 938 King Street RyejaLgok NY 10573 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) 1b.Business Telephone Number of Insured (203)394-2268 Enviroshield,Inc. Post Office Box 1296 lc.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/l/24 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 "Y' insures the business referenced above in box "Ia" 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 notijy the above certificate holder within 10 days IF policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named 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: tt�utG¢� 10u' � 12/15/2023 (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-I05.2(9-07) www.wcb.state.ny.us Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday,June 3, 2024 2:55 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 06/03/2024 14:54 To: VIL RYE BROOK PRIMARY Transmitted: 06/03/2024 14:54 00050 Ticket: 06034-002-529-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: SYLVAN RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: WE ARE REMOVING AN UNDERGROUND TANK FROM THE FROM LEFT OF THE RESIDENCE. AREA FLAGGED. NearSt: BETSY BROWN RD & CANDY LN Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 07/06/2024 Depth of excavation: 10 FEET Site dimensions: Length 10 FEET Width 10 FEET Start Date and Time: 06/06/2024 07:00 Must Start By: 06/21/2024 ------------------------------------------------------------------------------ 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: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1