License agreement for exterior cleaning, 65 Liberty Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler i-D1t ~-+o NYS DEC Permit # — q8 Tel.# ~IO — Z72 -3B67

Disposal Site(s) SorJXCrn A 1/r ej/ //

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

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal 0 Enclosure 0 Encapsulation 0 Repair - ❑ Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

OA 1 APATIA►1C AC AQATCIA LIT

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 sPnnklers, (e.9- entire, east win9• room p, (e.g. Pipe 99 n9. ceilin9• plenum lagging, FEET boiler room, lobby, etc) ducts. storage tanks, declmg, etc.) FEET ' removing and reptacing boilers. etc.)

5w 2 q cao~~ Fac.r~e gI 0

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 Prin Nam of Applicant I other than Owner) r

nature ignature nature

021a rf 03 Oz1 -c-o3 02/05 /o3 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 ntral-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 fc 2 E P D2/os jo3 Print Name of Owner Signature Date

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

Any modification of information provided on this form must be repertd 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. ACPT 2 o1

NYC-WTC 000093468