94 NASSAU STREET Block: 91 Lot: 13 BIN: 1001267 129 Fulton St, 40 Ann St., 129-133 Fulton St

NYC 9/11 Public Portal Document

TOO Mitt PECTION III~ORT (contlnuad) ~' yr ti CT(!!) 5=~ Z $' , 26. Asbestos Hauler tE51 , NV NYS DEC Permit # W— 462 •Tel.

Box accrs PA 1-T254 •:, Disposal Site(s) eip E L.AaOFIu. 10

filing of this form with NYC Department of Buildings) 27. This asbestos abatement is part of a (Item a through a requires c) O Sprinkler Replacement d) ❑ Renovation/Alteration a) ❑ Demolition b) ❑ Boiler Replacement e) O Fireproofing Replacement f) ❑ Other (Describe) boxes) 28. TYPE OF ABATEMENT (Check all appropriate ❑ Encapsulation O Repair O Clean up O Removal O Enclosure boxes) 29. ABATEMENT PROCEDURE (Check all appropriate O Full Containment O Glovebag ❑ Tent O DEP Variance Application / , k1336 t31✓

30. LOCATIONS OF ABATEMEN t scw f .r...'--.. --- OF ACM DESCRIPTION OF WORK BEING DESCRIBE SECTION AFFECTED SURFACES AMOUNT PERFORMED Floor(s) OF FLOOR CONTAINING ACM SQUARE UNEAR (e.g running cable, installing fire sprinklers. (e.g. entire, east wing, room M, (e.g. Pipe tagging, ceiling, plenum FEET FEET removing and replacing boilers, etc.) boiler room, lobby, etc) ducts, storage tanks, dedci , etc.

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

ku2z ~A►J Sons Ca►C1-¢ot wt ea@1 'P zC-~ e nt,G4L S Print Name of Applicant (if other than Owner) It Print ame of Asbestos tractor Pnnt Name of Ai nitor

Signature Signature

oe-19-02 as -I9-02

for the performance of asbestos abatement activity occurs, I am responsible 32. 1 understand that as the owner of a building where Asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance with the in asb tos project. I hereby declare that I have authorized the / monitor who is completely independent of all parties involved /- 1 filing of thisn otification for the work specified herein. a8-t9 — o 2 . • j ... yYCGEP raw Signature Data Prier Name of Owner THE WORK SITE. t'I ~ "ASTAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT 1 DEP ACP. Am i'rttfiiatinn of information orovided on this form must be reported immediately in writing directly to the NYC Rules may not be lawfully avoided or lessened requirements of the cremental or piecemeal fashion. ~t

NYC-WTC 000099007