Asbestos project notification form, 94 Nassau Street, 2002

NYC 9111 Public Portal Document I . - r — -.— ...i ' --~..—.. S .. .i r v `I (J N - 11 ASBESTOS INSPECTION REPORT (continued) .4 •

26. Asbestos Hauler IESI;NY NYS DEC Permitit NJ462 Tel.) (718) 522-2253 _ Disposal Si (s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254

27. This asbas>tos abatement is part of a (Item a through e requires filing of this form with NYC Depertntent of Buildings) e) 0 Demolition b) ❑ Boiler Replacement C) ❑ Sprinkler Replacement d) ❑ Renovation/Atteration e) 0 Fireproofing Replacement f) El Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application •-;:; Z/ ;__. ! ~~'~ 30. LOCATIONS OF ABATEMENT P'sr-4 AA d-rt? t At • O iii-, F' A A~M c f2.o. t c P -rA.t 1 DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET FEET removing and replaong boilers, etc.) 20oF Root= St,e.FAC 7000 tt PAao.P€TS 461 tt Gl 0 -n-~s '(4 TAc o.P Z345 !t prlc UW115 METAL 2370

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.

WAM ?AN Z elt3EE ______ Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner) /

nature" 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 air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. t L)Ep 0C. _ 02 Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. [pnymodificationof information rovided on this formmustbereportedimmediately inwritingdirectly 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 oiecemeal fashion_ ACP7 2/2001 I 1

NYC-WTC 000099018