47 MURRAY ST 1001436, 133/8

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPO continued) LL 26. Asbestos Hauler_______________________NYS DEC Permit O9 e

Disposal Site(s) U( €k ~ E r] 1 (/ ties 4(f( 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Afteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing. room X. (e.g. Pipe tagging, ceiling. plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers, boiler room, lobby. etc) ducts, storsge tanks. deck , etc.) FEET ' FEET removingand replacing boilers, etc.

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31. 1 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. C17A ,9i7; y ,ylT~c/ G Print N itor Prin Name/ As stos Contractor Pnnl Nam or App (cant (If other than Owner)

Signature nature Signature

o C - 03 -- 0 C 3 -c 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 fif g this notification for work spe i ed herein. Ii ~1 Print Name of Owner igneture to

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

An modification of 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 piecemeal fashion. pcpr V2001

NYC-WTC 000100210