NYC 9/11 Public Portal Document
ASBESTOS INSPECTION REPORT
PREMISE NO STREET INSPECTION DATE
SS 1'4''- r ST7 Qe (ct k -c) /72a~ c/ a !© // o
w SORO CODE QLOCK LOT SQUAD a BADGE.
nI OR
INSPECTOR or BLDG BASIS OF Qo .dQ2 PHaTOs TAKEN YES
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CONTRACTORS NAME 7 SAMPLE NO
R SAMPLE NO.
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SAMPLE NO.
STATENj /356 N6/- /"V
LABORATORY NAME OWNERS NAME
J-yi-84-6c Pa pC . ffairr Sit' r 7.
ADDRESS ADDRESS CITY
22-R Sf 4c S e-
STATE } STATE ZIP PHONE
ZIP J2PHO22-0630.
CONTACT PERSON: TIME OF INSPECTION FROM: pm TO: a
Inspection disclosed that the following Requirements, SpecificatIons.
and Procedures were complied with
O Section 141 Notifications, Reports, Plans. and Fees
O Section 1.71 Air Sampling, Monitoring, and Analysis
O Section 141 Worker Protection
O Section 1.101 Materials and Equipment
O Section 1-116 Work Place Preparation
Cl 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 & Removal
O Section 1-129 Maintenance of Decontamination System & Barriers
D Section 1-137 ACM Disturbance, Handling, & Removal
0 Section 1-138 Encapsulation O Section 1-139 Enclosure
O Section 1-140 Glovebag 0 Section 1-141 Tent
0 Ssctor. 1-146 -Preliminary Clean Up
O Section 1.147 Final Clean Up
O Project ongoing, expected completion date_J_I
O Project completed on or about , 1 1. All surfaces, Including abated surfaces are
free of visible ACM debris and Encapsulated
O No Access Premise 0 Locked, No response to bell or knocks ❑ Abandoned
D Inspection based on complaint, no ACM being disturbed or present
O Variance Inspection,Approved/Disapproved. Section (s)
D Follow Up Necessary
Contact person at the site... 1~~~`o`: L.'`f. 2, l . ..:: ~~ .. ..``.
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Additional Comments r
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NOV a (FRACTIONS RESULT CODE
Nova
SUPERVISORS INRIALS
TORO I - MANHATTAN 2 - BRONX 3 - BROOKLYN 4 - QUEENS $ -RICHMOND
$LDG TYPE A > e Stones a < a Stories C single Family
0 Sehoot E Hospital F Pubic Owned Property
RESULT CODES I - Violation Issued 2 - No Violations Issued 3 - No Access
4 - Project not Started INo NOV) 5 - Project Completed (No NOVI ACP 30192
NYC-WTC 000099841
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