WTC Site Record ID 000093187, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler ~D NYS DEC "ermft —~ Tel. 723 7 ) Disposal Sites) DU 11€k p-> (/~ ~'} {e S !— ,i 27. This asbestos abatement is part o1 a (Item a through a requires filing of this form wfth NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Afteration e) 0 Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent 0 DEP Variance Application 30. LOCATIONS OF ARATFUIFMT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g entire. east wing. man I. (e.g. Pipe tagging. ceiling. plenum SQUARE LINEAR (e.g. running cable. itstatling fire /prink ers. Ogler room. lobby, etc) ts. swage tanks. 0edt' . etc.) FEET * FEET remo,ng and repisong boilers. etc.)

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

Print U 1_ Prin Name Asbestos Contactor Print Nam of App ant (If th other than Owner)

Sgnature nature Signature

oC- o3-oa -~—OZ Date pate Date

32. I understand that as the owner of a building where asbestos abatement activity occurs. I em responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air monitor who is completely independent of all parties involved in the asbestos project I hereby declare that I have authorized the li of this notifi i for th work specified herein.

Pmt Name Owner Svwttn to

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE

LIAny modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. I S yr sr2oo1

NYC-WTC 000093190