Asbestos inspection report application, 59 [name] Manhattan, undated

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (con't.) Page2ofr

28. Methods of ACM Abatement (Check all appropriate boxes) a) ❑ Full Containment b) ❑ Repair c) ❑ Enclosure g) ❑ Clean up d) ❑ Glovebag e) ❑ Encapsulation 1) ❑ Tent g) ❑ Other, Specify

29. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings),, a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fire proofing Replacement f) ❑ Other, (Describe) Al only

30. LOCATIONS WHERE SUBJECT ABATEMENT TAKING PLACE

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF OF FLOOR CONTAINING FRIABLE ACM DESCRIPTION OF WORK BEING PERFORMED Actual FRIABLE ACM Floor(s) (e.g. entire, east wing, (e.g. Pipe lagging, ceiling, (e.g. running cable, installing fire room S. boiler room plenum ducts, storage .) tanks, SQUARE LINEAR sprinklers, removing and replacing lobby, etc.) decking, etc.) FEET FEET boilers, etc.)

6 south wing ceiling 5,75 r2 7o '4' -

Attach.additional sheet if necessary

31. I hereby declare that the information provided herein is true and complete to the best of my knowledge and that the air monitor is independent of the asbestos contractor. I am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work.

Glomar Corp. Grisdale Ball Inc. Grisdale Ball iic. Print Name of Air Monier ,_—f§int me of Asbestos Contractor Print Name Applkant

,r; . 4t/'! Slgnaturei Signature nature

12/19/01 12/18/01 12/18/01 Data Date Date

If Applicant is not the owner:

32. Authorization of Owner: I hereby declare that I have authorized the applicant to file the Application for the work specified herein and I have independently hired the air monitor in accordance with the NYC Asbestos Control Regulations.

59 Maiden Lane Ass. 12/19/01 Print Name of Owner Signature Date

NOTE: Storage, Transportation and Disposal of A est ontaminated Wastes is regulated by the NYC Department of Sanitation (LL 70/85) A validated photocopy of this form shall be kept at the worksite.

Any modification(s) of information provided on this form shall be reported immediately in writing directly to the NYC Department of Environmental Protection Asbestos Control Program 59-17 Junction Blvd., 8th Floor Corona, NY 11366-5107

THE PIECEMEAL CARRYING OUT OF AN OPERATION TO AVOID COVERAGE BY A STANDARD THAT APPLIES ONLY TO OPERATIONS OF A LARGER SIZE IS A VIOLATION FORM ACP7 2/94

NYC-WTC 000093142