Asbestos project notification form, 94 Nassau Street, 2002

NYC 9/11 Public Portal Document

4

ASBESTOS INSPECTION REPORT (continued) 1ESl , NY NYS DEC Permit # W- 462 Tel.# (1t8) 522 2 t6 3 26. Asbestos Hauler 60x 399 Sc DAL PA 12254 Disposal Site(s) 6Wk wDCE L:ANOFIU 'P0 Department of Buildings) 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration a) ❑ Demolition e) 0 Fireproofing Replacement f) ❑ Other (Describe)

2B. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Enclosure 0 Encapsulation 0 Repair 0 Clean up ❑ Removal

29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment 0 Glovebag 0 Tent ❑ DEP Variance Application nM •A~ co• ~F •( / 33 3U. LOCA 1 IONS ur ADA I Cm Grr 1 •-.....'- ^`^' ^ - - - AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING DESCRIBE SECTION PERFORMED Floor(s) OF FLOOR CONTAINING ACM LINEAR (e.g. Pipe tagging, ceiling. plenum SQUARE (e.g, running cable. installing fire sprinklers, (e.g. entire, east wing, room #, FEET FEET removing and replacing boilers, etc.) boiler room, lobby. etc) ducts, storage tanks, decking, etc.)

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I am familiar with Federal, 31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. State and NYC laws and regulations applicable to asbestos related work.

tOaetze,3 P s B• So Print Name of Ai nitor Print ame of Asbestos tractor Print Name of Applicant (If other than Owner)

Signature Signature gnature

06 -I9 -o2. Date Date Date

responsible for the performance of 32.-'1 understand that as the owner of a building where asbestos abatement activity occurs, I am with the Asbestos Control Program Rules. I have contracted the third party air ,-- the asbestos abatement activities in accordance as tos project. I hereby declare that I have authorized the ,; monitor who is completely independent of all parties involved in ,r fling of this:notification for the work specified herein. / . . ., _ OS^t9—o2 NYCtJEP Date Print Name of Owner Signature AVAILABLE AT THE WORK SITE. "^L' i'i .. °"A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE writing directly to the NYC DEP ACP. An modification of information provided on this form must be reported immediately in lawfully avoided or lessened The requirements of the Asbestos Control Program Rules may not be in incremental or iecemeal fashion. throw h the erformance of work #cpol

NYC-WTC 000099016