Asbestos project notification form, 114 Liberty Street, 2003

NYC 9/11 Public Portal Document

I k,

,SBESTOS INSPECTION REPORT (continued)

26.Asbestos Hauler Instate Transfer NYS DEC Permit # Tel.#

Disposal Site(s)

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) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) 0 Renovation/Alteration Clean Up e) 0 Fireproofing Replacement f) 0 Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Application '9

• —A—^&Ic P% Ov. LVV/111VI%17 'Jr AnATGIIGMT roe I I Ifl I , 1o9A "7

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING OF FLOOR CONTAINING ACM PERFORMED Floor(s) SQUARE LINEAR (e.g. running cable, installing fire sprinklers, (e.g. entire, east wing. room #. (e.g. Pipe lagging, ceiling, plenum FEET ducts, storage tanks, decking. etc.) FEET removing and replectng boilers, etc.) boiler room, lobby, etc)

Facade South,East and West Window Sills 100 Removai,Hepa Vacuum,Wetwipe

___________ Pg JVdAA ,J

familiar with Federal, 31. 1 hereby declare that the information provided herein is true and complete to the best of my knowledge. I am State and NYC laws and regulations applicable to asbestos related work.

Environmental Consulting &Mgmt. Lacen Contractiingge~sCorp. Lacen Contracting Corp. Print Name of As Co __P~Ap (H other Owner) Print Name of Air M itor

ee G41.

Signature Signature Signature

_ `7/C too __ Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance 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 here' . ) Ms. Denise Sweeny __ Print Name of Owner Sig re to

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

I_Any modification of information provided on this formmustbereportedimmediately in writingdirectly to the NYC DEP ACP. of the Asbestos Control Program Rules may not be lawfully avoided or AOP7 212001

NYC-WTC 000102549