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HomeMy WebLinkAboutRB25-0119 �yE DR c CLct L G . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 28,2026 Remy Tarnoff&Mina Tarnoff 140 Brush Hollow Crescent Rye Brook,New York 10573 Re: 140 Brush Hollow Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-120 As per the Certification letter from Enviroshield dated January 22, 2026, the removal of an underground oil tank under Mechanical Permit#RB25-0119 issued on 11/14/2025 has been satisfactorily completed. Sincerely, 4; 4 Steven E. Fews Building&Fire Inspector /to � 'c 4Rcb— O y� w � BUILDING DEPARTMENT �❑BUILDING INSPECTOR 1QASSISTANT 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 : L '7I D Q)'r(ACX1 Ilk O(I) QA&tJ - DATE: 1 - -1i7— 7it)Z(,& PERMIT# K.35- O 1 t ISSUED: • I •2SISECT: Z/ 4.7�- BLOCK:_LOT: 120 LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... 2 PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas We— r % v t CJ ,,\,cum 2Q eb — 2 7 — 2-02- ❑ L.P. Gas ,FUEL TANK ❑ FIRE SPRINKLER L (SSA ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BR(�k• • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS . DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BR(�� o y 198,2. a � El BUILDING DEPARTINIENT LDIN(.INSPEC IOR ASSISTAn1 BUILDINGINSPEC'I'O11 VILLAGE OF RYE BROOK ❑Com ENFORCLAIEN7'OF:FICGR 938 KING STREET • RYE BROOK, NY 10573 (914) 939-0668 FAx (914) 939-5801 www__rryebrgc►k.ors - - — — — — — - — - — — — - - - - — - - INSPECTION REPORT - - -- -- - - — - — — — — — — — - - — ADDRESS:_ 140 fir"Lk-sLbl;-16- cOO _ DATE:--Lz-- 17_ZO1.� PERMIT# i �,L ISSUED: SECT: BLOCK: L(YI : t _. LOCATION: OCCUPANCY: ❑ tUXATION Nori'.i) THE WORK IS... ❑ AcCEPTED ❑ RElI.C1-ED/ Rr;INSPF:('riON Qr SITE INSPECTION 14QUIRE1) ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS tR- �� I � I AO ❑ L.P.GAS 11, ❑ FUEL TANKr -- -• '� [7 O v i ❑ FIRE SPRINKLER *t satin �� A �,� �,� i �� A)-Pe ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER N C O 0 N ++ O N o „ v + o a aLn CAvm LL •� E > a, o � o0 Q, a v M v � L- V) m (v m W Ln p � m vta 3 W N E _ X 0z 0) oao w W v C N ` M O- w aJ L > C L � O CO > � �.'' � W \ 3 O a) v F- / o ~ L L LLl u ^ v ) N W O Ln v E O CO W 3 L o CN O N It �` _ N Y O N Y O d 'I ~ Z Cp a Z _ O o O L on o � a T uy W Y Y `� \ W W a o Y O G Y Z N d CO o w y v w W �• U J N m o m a o m u 2 66 c Q a O Y � J a W LU o >oO W co U E O ° � J o aoiTaCL m N 0 Z Q W W U M Ln rj p O W 3 •+ N .� Cl to Y d C. W O oo O E v � 'j m ei U O E CO `ri o v E O 0% •i �, � a z z Xt o v E a a, o �, W ` -j 410 uQ r o0 v _ � E oNu m o -0 m u , =v' o - > > -um' ov � U C � 0 cv�i vYs c �-1 L � 7 C W >- Ln CIO00 n �O N O as v E 3 m ca � 2 c D Q O � .It C14 a C O � L V W V1 N '� L r-I c-I Q W J N Ln J H Q C I , C O Ln r-I N o ,� o a r C. R o n n a C a E o o a 0 LL W V vY � ` � 0 or-C. r `o_ c72 _ E �,Ew yoR Q . a F, r cii C ' > E - '`- N ~ W J LLI W O N a} *' n�i a�i cc O coCC Q - Q co p. L U H o C u ^ u a/ ClC Yd W � C u °s d Q a a 0 :E v Y Fuel Storage Tank Permit Application Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester Project Information Permit Type Fuel Type Buried in Ground Fuel Oil #of Fuel Tanks Capacity of each Tank: Exact Location(s) of each Tank: 1 300-Gallon Removal The tank is located in the rear of the unit. Fuel Storage Tank Permit Application,page 1/1 �y DR(�j� VILLAGE OF RYE BROOK 938 King 5t Rye Brook,NY 10573 Q Y Phone:(914)939-0668 1 www.ryebrook.gov b2• Building Department Fuel Tank/Buried In Ground(Removal) Permit Permit Set 140 BRUSH HOLLOW CRIES P#RB25-0119 R#129.76-1-120 PERMIT INFORMATION Address Permit number Date issued 140 BRUSH HOLLOW CRIES RB25-0119 11/14/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Alfredo(Freddy)DiVitto adivitto@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS Cover page 1 Building Permit 2 Required Inspections 3 Contractor's Liability Insurance,Contractor's Workers Compensation Insurance(Showing Rye Brook 4-9 Cert Holder Property Owner/Homeowner Government ID,and/or Proof of Ownership 10-11 Site plan 12 Certificate of Occupancy,Certificate of Compliance,and Certification of Final Costs Application 13 Fuel Storage Tank Permit Application 14 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BR(�uk VILLAGE OF RYE BROOK O 938 King St Rye Brook,NY 10573 W :E Q Y Phone:(914)939-0668 1 www.ryebrook.gov > �O ��• b2• f Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQU[RED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE � ❑� 6ill REQUIRED INSPECTIONS Name Description Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading certificate. Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) 6 vm ENVIROSHIELD Clean. Preserve. Protect.'� January 22, 2026 Mr. Dominic Falcone Service Manager Westmore Fuel 86 North Water Street Greenwich,CT 06830 JAN 21 2026 Subject: Tank Removal, lanualy 9,20 Remy Tarnoff Residence 140 Brush Hollow Crescent Rye Brook.New York Dear Mr. Falcone: On January 9, 2026, Enviroshield completed the removal of one underground 330-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, 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 #26A0219, 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. 0 250 Moffitt St,Stratford,CT o6615 0 (203)38o-5644 0 infoaa enviroshield.com vwvw.enviroshield.con ENVIROSHIELD 71-W Clean. Preserve. Protect. Page 2 of 2 January 22,2026 Remy Tamoff Residence 140 Brush Hollow Crescent 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. 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 this work, please do not hesitate to contact me at your earliest convenience at (203) 380-5644. Sincerely, Enviroshield R9t,. Ponard Bochicchio Senior Project Manager Enclosures cc: Village of Rye Brook Building Department via email adivittoQryebrook.org Permit#RB25-0119 250 Moffitt St.Stratford.CT o6615 (9 (203)380-5644 0 infoca enviroshield.com wvwv,enviroshield.corr ENVIROSHIELD 1W Clean. Preserve. Protect. Site Photographs —Page 1 of 4 Remy Tarnoff Residence 140 Brush Hollow Crescent Rye Brook, New York _ Y — FEE '7n r I e - f _ s _• r '+�• ,,��. -jam''•'j'- 1 , R � • Location of 330-gallon underground storage tank (UST). Visible fill and vent pipes. D 250 Moffitt St,Stratford,CT o6615 13(203)380-5644 0 info@aenviroshietd.com 0 www.enviroshietd.cor ENVIROSHIELD Clean. Preserve. Protect. Site Photographs —Page 2 of 4 Remy Tarnoff Residence 140 Brush Hollow Crescent Rae Brook, New York t N ' iJ7.-Aor� ici'.S 4 r. t UST excavated and lifted from ground. D 250 Moffitt St,Stratford.CT o6615 0(203)380-5644 0 infooaenviroshield.com ®www.enviroshieid.cot ENVIROSHIELD Clean. Preserve. Protect. Site • .g of Remy Tarnoff Residence 41 Brush HoDow Brook,Rye • • - fix. K_ i .. I •i j1� jciN - q- -, •�• ,, ""M a.1. :r 71 �k•� �� Empty ENVIROSHIELD Clean. Preserve. Protect. Site Photographs—Page 4 of 4 Remy Tarnoff Residence 140 Brush Hollow Crescent Rye Brook, New York . - r 1 Syr ,6. Former location of 330-gallon LUST. Backfilled to grade. 250 Moffitt St,Stratford,CT o6615 Is (203)380-5644 0 info@enviroshield.com ® w wv.enviroshield.coi J ENVIROSHIELD Clean, Preserve, Protect. BILL OF LADING DESCRIPTION: Check applicable waste ID i' (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: VV! Total Quantity: I 0 gallons Generator Name: 'DOWN 1 e\IL G [old ko-. Site Address: 11 o Rrg5� �.J'ulte; ( ursc'pil City: Stater Zip: 10f2 ` Telephone: �71�S�, i�Q W.O#: Generator/Agent for Signature: Transporter: Enviroshield; 250 Moffitt Street, Stratford, CT 06615; 203-380-5644 Connecticut: CT-HW-495; New York: CT-095; Westchester County NY: WC-27310-H14; Connecticut H.I.C. 0703100 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) 0 250 Moffitt St, Stratford,CT 06615 0(203)380-5644 0 info(itenviroshield.conn Q wvwv.enviroshield.corr 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615 Fax:(203)377-9952 *9T e-mail:cetl@cetlabs.com COMR1111NVIROW&NIM 11611NC.INC. Client: Mr.Richard Louis Enviroshield,Inc. P.O.Box 1296 Stratford,CT 06615 Analytical Report CET# 26AO219 Report Date:January 16,2026 Project: Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY PO Number: 31523 Connecticut Laboratory Certificate:PH 0116 New York NELAP Accreditation: 11982 Massachusetts Laboratory Certificate:M-CT903 Pennsylvania Laboratory Certificate:68-02927 Rhode Island Laboratory Certificate: 199 Page 1 of 13 CET#:26AO219 Project:Tamoff, 140 Brush Hollow Crescent,Rye Brook,NY SAMPLE SUMMARY The sample(s)were received at 4.0°C. This report contains analytical data associated with following samples only. Sample ID Laboratory ID Matrix Collection Date/Time Receipt Date Tank Grave 26AO219-01 Soil 1/09/2026 10:00 01/12/2026 Analyte: Percent Solids ISM 2540 G] Analyst: IDD Matrix: Soil Datc/rime Laboratory ID Client Sample ID Result RL Units Dilution Batch Prepared Analyzed Notes 26AO219-01 Tank Grave 83 1.0 % l BA61326 01/13/2026 01/13/2026 13:54 Complete Environmental Testing,Inc. 80 Lupes Drivc,Stratford,CT 06615•TO:203-377-9984•Fax:203-377-9952•www.cetiabs.com Page 2 of 13 CET#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY Client Sample ID Tank Grave Lab ID: 26AO219-01 Semivolatile Organics Analyst:MJH Method: EPA 8270E Matrix:Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Naphthalene ND 120 1 EPA3545A BA61517 01/15/2026 01/15/2026 21:31 Acenaphthylene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/202621:31 Accnaphthenc ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Fluorene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Phenanthrenc ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Anthracene ND 120 1 EPA 3545A BA61517 01/152026 01/15/2026 21:31 Fluoranthcne ND 120 1 EPA 3545A BA61517 01/152026 01/152026 21:31 Pyrene ND 120 1 EPA 3 545 A BA61517 01/15/2026 01/15/2026 21:31 Benzo[a]anthraccnc ND 120 1 EPA 3545A BA61517 01/152026 01/15/2026 21:31 Chrysene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Benzo[b]fluoranthcne ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Benzo[k]fluoranthene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Benzo[a]pyrene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 lndeno[1,2,3-cdlpyrene ND 120 1 EPA 3545A BA61517 01/152026 01/15/2026 21:31 Dibenz[a,h]anthracene ND 120 1 EPA 3545A BA61517 01/15/2026 01/15/2026 21:31 Benzo[g,h,i]perylene ND 120 1 EPA 3545A BA61517 01/152026 01/15/2026 21:31 Surrogate:Nitrobenzene-0 74.1% 30-130 BA61517 01/15/2026 011151202621:31 Surrogate:2-F/uorobiphenyl 82.5% 30-130 BA61517 01/15/2026 011151202621:31 Surrogate:Terphenvl-d]4 93.0% 30-130 BA61517 01/15/2026 0111512026 21:31 Volatile Organics Analyst: FTR Method: EPA 8260D Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notcs Mcthyl-t-Butyl Ether(MTBE) ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 Benzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 Toluene ND 5.7 1.89 EPA 5035A-L BA61365 01/13/2026 01/13/2026 23:46 Ethylbenzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 m—pXylencs ND 11 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 o-Xylene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 Isopropylbenzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/202623:46 u-Propylbenzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 0 1 i 13/2026 23:46 13,5-Trimethylbenzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13202623:46 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984-Fax:203-377-9952•www.cctiabs.com Page 3 of 13 CET#:26A0219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY Client Sample ID Tank Grave Lab ID: 26AO219-01 Volatile Organics Analyst: FTR Method: EPA 8260D Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes tort-Butylbenzenc ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/2026 23:46 1,2,4-Trimethylbenzene ND 5.7 1.89 EPA 5035A-L BA61365 01/13/2026 01/13/2026 23:46 sec-Butylbenzene ND 5.7 1.89 EPA 5035A-L BA61365 01/13/2026 01/13/2026 23:46 4-isopropyltolucnc ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/2026 23:46 n-Butylbenzene ND 5.7 1.89 EPA5035A-L BA61365 01/13/2026 01/13/2026 23:46 Naphthalene ND 11 1.89 EPA5035A-L BA61365 01/13/2026 01/13/2026 23:46 Surrogate:1.2-Diehloroethane-d4 98.5% 70-130 BA61365 01/13/2026 0111312026 23:46 Surrogate:Toluene-d8 98.7% 70-130 BA61365 01/13/2026 0111312026 23:46 Surrogate:4-BromoJluorohenzene 99.2% 70-130 BA61365 01/13/2026 0111312026 23:46 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#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY QUALITY CONTROL SECTION Batch BA61365-EPA 8260D Result RL Spike Source %Rcc RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BA61365-BLKI) Prepared: 1/13/2026 Analyzed:1/13/2026 Methyl-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-Xylenc ND 2.5 Isopropylbenzene ND 2.5 n-Propylbenzenc 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-Isopropyltoluene ND 2.5 n-Butylbenzene ND 2.5 Naphthalene ND 5.0 Surrogate:l,1-Dichloroethane-d4 97.5 70-130 Surrogate:Toluene-& 99.7 70.130 Surrogate:4-BromoJluorohen_ene 103 70.130 LCS(BA61365-BSI) Prepared: 1/13/2026 Analyzed: 1/13/2026 Methyl-t-Butyl Ether(MTBE) 49.8 2.5 50.000 99.5 70-130 Benzene 51.4 2.5 50.000 103 70-130 Toluene 50.5 2.5 50.000 101 70-130 Ethylbenzene 48.0 2.5 50.000 96.0 70-130 m*p Xylenes 96.4 5.0 100.000 96.4 70-130 o-Xylene 49.5 2.5 50.000 99.0 70-130 Isopropylbenzene 50.9 2.5 50.000 102 70-130 n-Propylbenzene 49.6 2.5 50.000 99.1 70-130 1,3,5-Trimethylbenzene 49.8 2.5 50.000 99.6 70-130 tert-Butylbenzene 49.1 2.5 50.000 98.2 70-130 1,2,4-Trimethylbenzenc 49.8 2.5 50.000 99.7 70-130 sec-Butylbenzene 48.9 2.5 50.000 97.7 70-130 4-lsopropyltolucne 48.8 2.5 50.000 97.7 70-130 n-Butylbenzene 48.2 2.5 50.000 96.4 70-130 Naphthalene 46.2 5.0 50.000 92.3 70-130 Surrogate:1,1-Dichloroethane-d4 96.3 70-130 Surrogate:Toluene-d8 101 70-130 Surrogate:4-BromoJluoroben-ene 102 70-130 LCS Dup(BA61365-BSDI) Prepared: 1/13/2026 Analyzed: 1/13/2026 Methyl-t-Butyl Ether(MTBE) 48.0 2.5 50.000 96.0 70-130 3.58 20 Benzene 44.1 2.5 50.000 88.1 70-130 15.3 20 Toluene 45.6 2.5 50.000 91.2 70-130 10.2 20 Ethylben2ene 44.2 2.5 50.000 88.4 70-130 8.29 20 m-p Xylcncs 88.5 5.0 100.000 88.5 70-130 8.57 20 o-Xylene 46.0 2.5 50.000 92.1 70-130 7.22 20 lsopropylbenzene 48.6 2.5 50.000 97.1 70-130 4.70 20 n-Propylbcnzenc 48.2 2.5 50.000 96.3 70-130 2.89 20 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•TO:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 5 of 13 CET#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes LCS Dup(BA61365-BSDI)-Continued Prepared:1/13/2026 Analyzed:1/13/2026 1,3,5-Trimethylbenzene 45.5 2.5 50.000 91.0 70-130 9.09 20 test-Butylbenzene 47.7 2.5 50.000 95.3 70-130 2.98 20 1,2,4-Trimethylbenzene 47.6 2.5 50.000 95.3 70-130 4.51 20 sec-Butylbenzene 48.1 2.5 50.000 96.3 70-130 1.53 20 4-Isopropyltoluene 47.1 2.5 50.000 94.2 70-130 3.67 20 u-Butylbenzene 47.3 2.5 50.000 94.6 70-l30 1.89 20 Naphthalene 47.4 5.0 50.000 94.9 70-130 2.71 20 Surrogate:1,2-Dtchloroethane-d4 100 70-130 Surrogate:lblu~48 101 70-130 Surrogate:4-Brnmofluor oben:ene 101 70-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 6 o 113 CET#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY Batch BA61517-EPA 8270E Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BA61517-BLKI) Prepared: 1/15/2026 Analyzed:1/15/2026 Naphthalene ND 100 Acenaphthylene ND 100 Acenaphthene ND 100 Fluorene ND 100 Phenanthrene ND t00 Anthracene ND 100 Fluoranthene ND 100 Pyrene ND l00 Benzo[a]anthracene ND 100 Chrysene ND l00 Bcnzo[b]fluomnthene 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 Surrogate:Nitrobenzene-d5 60.4 30-130 Surrogate:2-Fluorobiphen.0 65.3 30-130 Surrogate:TerphenvWN 70.3 30-130 LCS(BA61517-BSI) Prepared: 1/15/2026 Analyzed: 1/15/2026 Naphthalene 3070 100 4,000.000 76.6 40-140 Acenaphthylene 3570 100 4,000.000 89.1 40-140 Acenaphthene 3430 100 4,000.000 85.8 40-140 Fluorcnc 3480 100 4,000.000 87.1 40-140 Phenanthrene 3390 100 4,000.000 84.9 40-140 Anthracene 3460 100 4,000.000 86.5 40-140 Fluonmthenc 3400 100 4,000.000 85.0 40-140 Pyrene 3390 100 4,000.000 84.7 40-140 Benzo[a]anthracene 3300 100 4,000.000 82.4 40-140 Chrysene 3490 100 4,000,000 87.2 40-140 Benzo[b]fluoranthene 3420 100 4,000.000 85.4 40-140 Bcnzo[k]fluomnthene 3450 100 4,000.000 86.3 40-140 Benzo[a]pyrene 3570 100 4,000.000 89.4 40-140 lndeno[1,2,3-cd]pyrene 3380 too 4,000.000 84.5 40-140 Dibenz[a,h]anthracene 3410 100 4.000.000 85.2 40-140 Benzo[g,h,i]perylene 3410 100 4,000.000 85.3 40-140 Surrogate:Nitrobenzened5 84.9 30-130 Surrogate:3-Fluorobiphenyl 833 30-130 Surrogate:Terphenvl-dl4 85.2 30-130 LCS Dup(BA61517-BSDI) Prepared: 1/15/2026 Analyzed: 1/15/2026 Naphthalene 2920 100 4,000.000 72.9 40-I40 4.93 30 Acenaphthylene 3510 100 4,000.000 87.6 40-140 1.69 30 Acenaphthene 3310 100 4,000.000 82.8 40-140 3.62 30 Fluorene 3430 100 4,000.000 85.7 40-140 1.65 30 Phcnanthrcnc 3400 too 4,000.000 84.9 40- 140 0.0621 30 Anthracene 3480 100 4,000.000 87.1 40-140 0.681 30 Fluoranthene 3500 100 4,000.000 87.6 40- l40 2.99 30 Pyrenc 3460 too 4,000.000 86.6 40-140 2.20 30 Benzo[a]anthracene 3360 100 4,000.000 84.0 40- 140 1.90 30 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 7 of 13 CET#:26AO219 Project:Tamoff, 140 Brush Hollow Crescent,Rye Brook,NY Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes LCS Dup(BA61517-BSD 1)-Continued Prepared: 1/15/2026 Analyzed:1/15/2026 Chrysene 3500 100 4,000,000 87.5 40-140 0.328 30 Benzo[b]fluoranthene 3440 100 4,000.000 86.1 40-140 0.846 30 Benzo[k]fluoranthene 3500 100 4,000.000 87.6 40-140 1.49 30 Benzo[a]pyrene 3620 100 4,000.000 90.4 40-140 1.15 30 Indeno[1,2,3-cd]pyrene 3390 100 4.000.000 84.9 40-140 0.418 30 Dibenz[a,h]anthmcene 3410 100 4,000.000 85.2 40-140 0.0863 30 Benzo[g,h,i]peryiene 3430 100 4,000.000 85.8 40-140 0.612 30 Stu ogate:Nitrobenzene-d5 81.7 30-130 Surrogate:2-Fluorobiphenvl 80.6 30-130 Surrogate:Terphenyl-d14 87.0 30-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cctiabs.com Page 8 of 13 CET#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY T 80 Lupes Drive Tel:(203)377-9984 Stratford,CT06615 u'1WPIiil iNVIAONMINiA1118TING,ING Fax:(203)377-9952 email:cetlGcetlabs.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 analyze 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. 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. oho Connecticut Laboratory Certification PHO116 Leo New York NELAYAccreditation 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•www.cetiabs.com Page 9 of 13 CET#:26AO219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY All questions related to this report should be directed to David Ditta, Timothy Fusco,or Jeffrey Smith at 203-377-9984. Sincerely. This technical report was reviewed by Jeffrey Smith Y. 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 Relative Percent Difference(RPD)falls outside of control limits. +- The Surrogate was diluted out. *CI-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•www.cetlabs com Page 10 0f 13 CET#:26A0219 Project:Tarnoff, 140 Brush Hollow Crescent,Rye Brook,NY CERTIFICATIONS Certified Analyses included in this Report Aoalyte Certifications EPA 8260D in Soil Methyl-t-Butyl Ether(,MTBE) CT,NYPA Benzene CT.NYPA Toluene CT,NYPA Ethylbenzcnc CT,NYPA m+p Xylenes CT,NYPA o-Xylene CT,NYPA Isopropylbenzenc CT,NYPA n-Propylbenzene CT,NYPA 1,3,5-Trimcthylbenzcnc CT,NY,PA ter(-Butylbenzene CT,NYPA 1,2,4-Trimethylbenzene CT,NYPA sec-Burylbenzene CT,NYPA 4-Isopropyltoluene CT,NYPA n-Burylbenzene CT,NYPA Naphthalene CT,NYPA EPA 8270E in Soil Naphthalene CT,NYPA Accnaphthylcne CT,NYPA Acenaphthcnc CT,NYPA Fluorene CT,NY,PA Phenanthrene CT,NYPA Anthracene CT,NYPA Fluoranthcnc CT,NYPA Pyrene CT,NYPA Benzo(a]anthracenc CT,NYPA Chryzene CT,NYPA Benzo[b]fluoranthene CT,NYPA Benzo[k]fluoranthenc CT,NYPA Bervo(a)pyrene CT,NYPA Indeno[l,2,3-cd]pyrene CT,NYPA Dibenz[a,h]anthracene CT,NYPA Benzo(g,h,ilperylene CT,NYPA SM 1540 G in Soil Percent Solids CT Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 11 of 13 CET#:26AO219 Project:Tarnoff,140 Brush Hollow Crescent,Rye Brook,NY Complete Environmental Testing operates under the following certifications and accreditation: Code Description Number Expires CT Connecticut Public Health PH0116 09/30/2026 NY New York Certification(NELAC) 11982 04/01/2026 PA Pennsylvania DEP 68-02927 05/31/2026 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tcl:203-377-9984•Fax:203-377-9952•www.cctlabs.com Page 1of3 #BION 1 •1NOO d0 a-IH1O.L 0 m M N Q r cm o C L cF rcarm o� � ❑ Q v o � y cn ti V S O m cn a ❑ 3 om, m o w E f 1 m m S s C a a 7 ti dl`Jl Y U _''`_ IC_h . dld5 a 0 LLL � V7� l U V (n d 1 • W q ❑ 4el❑+�L�PPL-1 C 0- Q O �- fn F J m O *1 a a v Q � panlossc SWWA St d33010 Q I uni O �pl�W EL'o4d,t7!�oud N Z E fn •. `1 � � w V •o11r� Hd131O U s2p*!Wad oM�� sg0d a LL LL N H O HVdm"d OLZ9 s�µn&p eNeM1N-u109 01-ZO O Z: 'm o Z 09Zs—0?0 V I 7 Z, m n Q —BOMH 09Z9 uj ' o 0 Up o 0 S_a p R�dF!0938 m O O n o W CC � U s�uef JO eme10A 09Z9 z U o¢ v ?C4 a � U Y .Apo omi Q c3 ,Ae0 yXQN J lr ID Oyu F •AL,Q aweg .- m o. g4a "' m 9 c a�33o��b� Oi 8 Y r O Ill m m a s � n o 0 _ a= W 3 tNaEE o O °o >. > > n W rn rn o " E v cwi w °' u .DF a a) ° _ cr cc c W m � o m CD ��—°m o m n o � n M CryEl cmi Q C•) 0 Z O CVN®® Z V C LL rcTLL, CIL m u7 m o o cn vi ¢ a a G I F v o� as rn 0 0 0 • O ca cc • Y (E L Z O C I a E n IF E m $ z O "' u. n E �� a m as _ E O a _S ( mn E S t^ ra— CD �? w t m aunt m CDQ 1° 0. r > > Q co m D U m N F 0 0 o Lu w m E O U v E!!!R,oul -0 tl� Q w m m n = m > z =N o` Ew Q 0 a o w mN o c (q z z z n1`' m O ` Q O O J J J 1 E �`U a I O 1 7 0o to (_ U U) ¢ ¢ ¢ U cg a v UL a Q a ENVIROSHIELD Clean. Preserve. Protect. 33d. SCALE PURCHASE TICKET P.C. Metals, Inc. 270 Central Avenue Bridgeport, CT 06607 203-367-9328 Ticket: 620898 Weigh In: 01/09/2026 13:54 Customer: 1034 Weigh Out: 01/09/2026 13:54 ENVIRO SHIELD Bridgeport, CT Commodity Gross Tare Net Price TOTAL$ UNP TANK 600 0 600 /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. 0 250 Moffitt St,Stratford,CT o6615 0(203)380-5644 0 infoca enviroshield.com :!!, vw w.enviroshield.con The Arbors Homeowners' Association 173 '/2 Ivy Hill Crescent Rye Brook, NY 10573 December 22Id, 2025 Remy and Mina Tarnoff 140 Brush Hollow Crescent Rye Brook, NY 10573 Re: Above Ground Oil Tank Dear Remy and Mina, The Architecture and Grounds Committee (A&G) and the Board have reviewed your application for the above-named work. The application is approved and will require screening or painting of your tank. The paint color would match the house color. This will be determined after installation. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager VILLAGE OF RYE BROOK-BUILDING DEPARTMENT 938 KING STREET-RYE BROOK,NY (914)939-06681 www.ryebrook.org Q. Fuel Tank / Buried In Ground (Removal) Permit PERMIT#: RB25-0119 ISSUED: 11/14/2025 EXPIRES: 11/14/2026 ADDRESS: 140 BRUSH HOLLOW CRES PARCEL ID#: 129.76-1-120 PARTIES: Applicant Property owner Enviroshield RemyTarnoff Leonard Bochicchio 140 Brush Hollow 250 Moffitt Street Rye Brook,NY 10573 Stratford,Connecticut 06615 License number Home Improvement Lic:WC-27310-H14 PERMIT1.THIS CONSPICUOUSLY NOTICE 2.A COPY FT E A PROVED PLANSMUST BE KEPT ON SITE. SITE. Hours of Operation of Construction Equipment/Village Code§158-4:WEEKDAYS-8:00am to 6:00pm or dusk,whichever is earlier; SATURDAYS-9:00am to 4:00l-SUNDAYS&HOLIDAYS-No Construction Activity Allowed This permit is valid for a period not to exceed twelve(12)months from the date of issuance,and covers only that work listed above.Separate permits are required for any electrical,plumbing,fire suppression.fire/smoke/carbon monoxide detectors/alarms,or any other work not covered under this permit.The approved plans must be kept on the job site&be made available for review by the Building Department upon demand.Any amendments or changes to the approved plans must be designed by your architect/engineer and submitted to the Building Department for review and approval prior to performing the work. �^ Steven E.Fews Building&Fire Inspector Q�E 4R(��. ' 1982' BUILDING DEPARTMENT 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 : ' 1 � DATE: L6A2� PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: G OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMB G NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING [I INSULATION ❑ Natural Gas �' ✓ ❑ L.P. Gas FUEL TANK FIRE SPRINKLER ru l ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Y- ENVIINC-01 JSILVA DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/4/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mary Tomaselli Gowrie Group ;PHONE FAx 70 Essex Road (AC.No.Ea*(860)399.2838 (AIC,No):_ _ Westbrook,CT 06498 ADDRESS;mtomaselllWsk-MAIL INSURER(31 AFFORDING COVERAGE _ _AI S INSURER^:Nautilus_Insurance Compaq 17370 INSURED I_wsuaexe:Great Divide Insurance Company 25224 Enviroshleld Inc.and E.G.Kost Rental,LLC INSURER C: _ PO Box 1296 -- — - — 250 Moffitt Street INSURER D: _ Strafford,CT 06615 INSURER E__ 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. _ I ISR TYPE OF INSURANCE ADDL SU POLICY NUMBER POLICY EFFJJ& POLICY EX 2. O A X COMMERCIAL GENERAL LIABILITY EAACAyH�O�CCURRENCE 1,000,000 CLAIMS-MADE I X OCCUR ECP01521982-25 I 12/1/2024 12M/2025 pl;EM1SE$iOF.RaENoccu�anca 100,000 X Pollution Liability 5,000 MED EXP(Any oneperson iX Professional Liab PERSONAL a ADV INJURY 1,000,000 GENLAGGREGA LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER III B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 000 _{Eap�tylr,D _ '— ANY AUTO BAP1521979 25 12/1/2024 12/1/2025 BODILY INJURY(Per pe 3 OWNED SAUTOS CHEDULED 80 ILY INJURY(Per accident) HHOWNE�S ONLY X SCHEDULED E X AMCSIRS ONLY X.E AUTOS ONNLY A UMBRE"UAe X OCCUR 1 EACH URRENCE_ 1,000,000 OCC X EXCESS LUW CLAIMS-MADE FFX 2036752 13 12M/2024 12/1/2025 AGGREGATE 1,000,000 DED 1 X I RETENTIONS 10,000 B AND EMPLERSOYERS'LIABILITY YIN X I PFJTMIF'i Tµ. i ANY PROPRIETORIPARTNER/EXECUTNE CA 1521980 24 12/7I2024 12/1/2025 1,000,000 OFFICETMJMBEREXCLUDED4 NIA L.EACHACCIDENT S lMa Idatory I NH) _E.L.DISEASE-EA EMPLOY S 1,000,000 if yes,describe unde DESCRIPTION OF OrPERATIONS below EL DISEASE-POUCY UA4T l S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1111,Addklonal Remarks Schedule,may be attached If more space Is required) Village of Rye Brook is listed as Additional Insured for General Liability where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Village of Rye Brook 938 King Streetl /! __$ye_Btgok NY 10 �► 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 1a.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (203)394-2268 Enviroshield,Inc. Post Office Box 1296 le.NYS Unemployment Insurance Employer Stratford,CT 06615 Registration Number of Insured Work Location of Insured (Only required if coverage is Id.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up 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"Ia" BAP1521979-25 Village of Rye Brook 938 King Street 3c. Policy effective period Rye Brook,NY 10573 12/I/24 to 12/1/25 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 "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 may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whicherver 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,1 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 authorzed representative or licensed agent of insurance carrier) Approved by: Vi,vi.GevvF M. ELL_ca n.o 1 1/25/2024 (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