WTC Debris Clean-up Permit Application, Jun 2002

NYC 9/11 Public Portal Document

ASBESTOS IN E TION REPORT (continued) soestos Transportation 26. Asbestos Hauler ,p - NYS DEC Permit # 1 A- 3 71 TEL.# 631-924-5050 Disposalsite(s) Imperial/POB 47, 11 :Boggs Rd., PA; Southern Allleeghenies/Rd 3 27. This asbestos abatement is part of a (Item a through e requires filing of this Form with r NY~uepartentof Bulldnts)PA a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ 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 0 Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room p, SQUARE PERFORMED (e.g. Pipe lagging, ceiling, plenum LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts. storage tanks, decking, etc.) FEET NE removing and replacing boilers, etc. Roof Item No. 2 >erimeter and 4,95 localized areas

Roof Item No. 4 Gravel Roof 90

Facad Item No. 7 North Facade 4,751

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.

Warren & Panzer Eng. Trio Asbestos Removal PnntName of Air Monitor NYC t Nam of tos ContraetorCO r p Print Nam licant (if other than Owner)

La {

Sign ure Signature Signature

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 Control Program Rules. I have contracted the third party pir monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have a horize the riling of this notification for the work specified herein. AM Property Holding .Co. c/o NYC C) Z' Print Name of Owner c%-.-.- Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. [A ny modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the p Program Rules may not be lawfully avoided or lessened ACP7 through the work in incremental or piecemeal fashion. 212001

NYC-WTC 000093688