Contract specifications for decontamination, 53 Park Place, Nov 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) I 26. Asbestos Hauler Tri State Transfer/ATC NYS DEC Permit # 1A-375/IA-371 TEL.# Disposal Sita(s)( reenridge Landfill, 1 Landfill Rd, Scottsdale, PA / Meadowfill Landfill, Rte 2, Box 68, Bridgeport 27. This asbestos abatement is part of a (item a through a requires filing of this form.with NYC Department of Buildings) e) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration „e) ❑ Fireproofing Replacement 9 d✓ Other.(Describe) Environmental Clean Up

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal ❑ Enclosure d Encapsulation ❑ Repair 0 Clean up•

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

I 30. LOCATIONS OF ABATEMENT

Floor(s) DESCRIBE SECTION OF FLOOR AFFECTED SURFACES CONTAINING ACM AMOUNT OF ACM // DESCRIPTION OF WORK BEING tee. entire. oast wing. room C. (eg. Pipe legging. ceiling, ptentrn SQUARE LINEAR PERFORMED (e.g. Wanting nee. iriaiamng file sptirtkten. boilm room. IobbV. atcp doers. storage tanks. dedung. sic) FEET FEET removing andd r cing boilers.da PH Entire Debris Clean-Up -• •9.200 Environmental Clean Up I 11 ntire Debris Clean Up 9,200 Environmental Clean Up 10 ntire Debris Clean Up 9.200 Environmental Clean Up 9 Entire Debris Clean Up 9,200 Environmental Clean Up 8 Entire Debris Clean Up 9,200 Environmental Clean Up

I 7 6 - Entire Entire Debris Clean Up Debris Clean Up 12,000 12,000 Environmental Clean Up Environmental Clean Up

I 5 4 ntire Entire Debris Clean Up Debris Clean Up 12.000 12,000 Environmental Clean Up Environmental Clean Up 3 .. - tine - •-'--=_ •• - Debris Clean Up 12,000 Environmental Clean Up I 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.

I EM & CA PMt Name of Air Monitor Pinnacle Environmental Corp Print sme of A$besioe Contractor Pinnacle Environmental Corp Print Name of App5Kant (If other then Ow'ier)

I y~o~D,O, Signature Signature

uJ ~ Signature

UI (1/SIG!

I Date _ Oe

32. 1understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted performance of Date

monitor who is completely independent of all parties involved in the the third party air

I filing of this notification for the work specified herein. Ltonshead 110 Development LLC.clo Worldwide tos jest. I hereby declare that I have authorized the

11- - o!

w Print Name of owner Hold ios Inc Ignattue Cato A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. L_Any modification of information provided on this form must be reported immediately In writing directly o the NYC DEP ACP.

I The requltements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throu h the performance of work In Incremental of piecemeal fashion. AC.P7 WM1

I

I n NYC-WTC 000098608