Permit application for remediation work, 80 Nassau Street, Aug 2002

NYC 9/11 Public Portal Document

So t ASSA0 S-reee--r ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY r NYS DEC Permit # NJ-462 Tel.# (718) 1522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Aferation e) 0 Fireproofing Replacement f) El 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 ❑ Glovebag ❑ Tent 0 DEP Variance Application / iJ /t'ko a'- 30. LOCATIONS OF ABATEMENT ROOF MA-n iA t_ eOOf UEwt gp&, %c ('rasz.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 tagging. ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts. storage tanks. decking, etc.) FEET FEET removing and replacing boilers, etc.)

QQOF F SuRc cE. 7244 Ii ___ 464 it L3~k t1c'ADs 2040

_ 200 _

12XD u 1000 7tsF E CAI t ___ tt WET cispc S 2.2rD

Snum-t 504

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.UA 0e PA-PZC-a atacE,tu BgJOJAMIN VIAZZLI4l5 5 spa Cv̀ttt t Print Name of it Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

______

o to _//o 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.

Nycpep 06 128 (OZ Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

LA ny modification of information provIded on this form must be reported immediately in writing directly 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 piecemeal fashion. zrzoot

NYC-WTC 000099464