NYC 9/11 Public Portal Document
ASBESTOS INSPECTION REPORT
PREMISE Na N
STREET I .!ow,iE N DATE
5_ 3cuc 57 ,Vrr (a-dtn)
-
F100R ZIP aORO CODE BLOCK Lor SQUAD a BADGE.
I ' / A~7S
INSPECTOR R . BLDG BASIS OF INSPECT 77L,CJ /6 ?O ,n,e'0'2.. PHOTOS TAKEN YES
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CONTRACTORS NAME SAMPL.ENO.
i ria
Aq SAMPLE NO
/~ 2-e /2 Serf C %/ a
STATE ►HON6/_ SAMPLE NO.
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LABORATORY NAME OWNERS NAME
GIXVP.w st GLn fC . //vrr 1 k -v".
ADDRESS e~ ADDRE CITY
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STATE STATE ZIP PHONE
ZIP 2PHO22-0630.
CONTACT PERSON: TIME OF INSPECTION FROM: TO: em )
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Inspection disclosed that the following Requirements, Specifications,
and Procedures were compiled with
O Section 141 Notifications, Reports, Plans, and Fees
O Section 171 Air Sampling, Monitoring, and Analysis
O Section 141 Worker Protection
O Section 1.101 Materials and Equipment
O Section 1.116 Work Place Preparation
O Section 1.117 Worker Decontamination Enclosure System
O Section 1.118 Waste Decontamination Enclosure System
O Section 1.126 Engineering Controls O Section 1.127 EntrylExit
❑ Section 1.128 Equipment, Waste Decontamination d Removal
O Section 1-129 Maintenance of Decontamination System & Barriers
O Section 1.137 ACM Disturbance, Handling, & Removal
O Section 1.138 Encapsulation 0 Section 1-139 Enclosure
O Section 1.140 Glovebag 0 Section 1-141 Tent
O SictIN11 i•143 -Preliminary Clean Up
O Section 1.147 Final Clean Up
O Project ongoing, expected completion dote_J 1
O Project completed on or about .J_I_kll surfaces. including abated surfaces are
free of visible ACM debris and Encapsulated
O No Access Premise O Locked, No response to bell or knocks O Abandoned
O Inspection based on complaint, no ACM being disturbed or present
❑ Variance Inspection,ApprovedlDisapproved. Section (s)
O Follow Up Necessary
Contact person at the site....VI. hovdl~h `F 2 ~^ `'r/v ..:: ....::.`.ir . :: y cv
Alla, Y14Lt WI & !f(
Additional Comments V
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NOV a INFRACTIONS RESULT CODE
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NOV a SUPERVISORS INITIALS
• - wffff, Mn ( . •NVNA JS sr+UVFLTN A . wvtLNS 5 .RICHMOND
$1.D0 TYPE A > 6 Stories B < 6 Stories C Single Family
0 school - E Hospital F Punic Owned Property
RESULT CODES I - Violation Issued 2 - No roletions Issued 3 • No Access
A • Project not Started (No NOV) 5 - Protect Completed (No mov) ACP 30192
NYC-WTC 000099825
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