Permit application for DEP work, 63 Nassau Street, Sept 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler __ I ES I , N~` NYS DEC Permit # I -462 —_ Tel.# (it t,) S2?- 2:2' 3

Disposal Site(s) —1,g33DFtt:L P 0 Box 39 ScersDA PA iz254 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) . a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement f) ❑ Other (Describe) _------ —_~—_--- --- ______-

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application c :~/j l~f 30. LOCATIONS OF ABATEMENT 2cc F mATE RtA L . t2C0F MFM(32' t C 'FAR') / I (S I 3 <vv — DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room p, (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.)

ROOF ROOF Sutz.FACE t 125

It MEc ACES 200 sr BAC ___ fZGC_ _ 500

N A'C ut t STS 5 b'e'ars 1Z

FACADE ; D£ 1500

tt €t oti Sc.C4 ACE I $75 ii a SiUPE t;'Qt>ntT /, t iaN7 5 $'GO

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.

00ARPEN 1 'PAN Z-ER &G 1 WEARS B• ICu z B Aw 4 S N µTQot I NC Print Name of Air Monitor ~rij Name of lbktos Contractor Print Name of Applicant (If other than Owner)

'Signature Sign Lure . 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 a bestos project. I hereby declare that I have authorized the •filing of this notification for the work specified herein. •t .~ ~ N/CDta t)9-2Z-0 Z Print Name of Owner Signature Date

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

Any 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. ACP7 212001

NYC-WTC 000099876