License agreement for exterior cleaning, 65 Liberty Street

NYC 9/11 Public Portal Document z

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler J_O 0 NYS DEC Permit # Tel.# 7-2 -3B67

Disposal Site(s)So A )I Aa.117as , V Py £ -'4 d// ~

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) O Demolition b) O Boiler Replacement c) O Sprinkler Replacement d) O Renovation/Alteration e) O Fireproofing Replacement 0 O Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) O Removal O Enclosure O Encapsulation O Repair -- O Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application on I APATIf'►IC AC AQATCIACLIT

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM . 'PERFORMED SQUARE LINEAR (e.g. running cable, installing fire P sprinklers, (e.9~ entire, east win9• room p, n9• ceilin9• plenum lagging. (e.g. Pipe 99 FEET ' FEET removing and replacing reptacing boilers. etc.) boiler room, lobby, etc) ducts. storage tanks, decking, etc.)

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

Print Nam of Air Monitor Pri ame of estos Contractor Prim Nam of Applicant I other than Owner)

nature ignature nature

021a r/03 02/ %3 /o; Date Date --~- Date

32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos C otrol-Progra-m-Rules. I have contracted the third party air monitor who is completely independent of all parties involved in asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. r f c a E• P f Oz aS jo3 Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING MENDMENTS MUST BE AVAILABLE AT THE WORK SITE. I Onv mnrlifirntinn of information nrnvided on this form must be'iperted immediately in writing directly to the NYC DEP ACP. I

The requirements of the Asbestos Control Program Rules may riot-be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. ACP)

NYC-WTC 000093468