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Asbestos project notification form, February 2003

Machine-extracted title · confidence 85%

Asbestos project notification and inspection report form required for NYC DEP and Department of Buildings submittal.

NYC-WTC_000102602–000102604

Folder label: “SCOPE OF WORK ADDENDUMS WORK SCHEDULE

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Scanned page image, NYC-WTC_000102603
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NYC 9/11 Public Portal Document

FEB.26.2003 6:02PM ETS INC. NO. 543 P. 3

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler Tri-State Transfer NYS DEC Permit # 1A375 Tel.# 18) 617-0661

Disposal Site(s) BFI Imperial Landfill, 11 Boggs Road, PO Box 47, Imperial, PA 15126 27. This asbestos abatement is part of a (item a through a requires thing of this form with NYC Deparament of Suitdings) s) © Demolition b) 0 Boiler Replacement c) ® Sprinkler Replacement d)13 Renovation/Aiterstion e) 0 Flreprooting Replacement i) 8 Other (Describe) ACM Removal

28. TYPE OF ABATEMENT (Check all appropriate boxes) ® Removal ❑ Enclosure ® Encapsulation ❑ Repair [a Clean up 29. ABATEMENT PROCEDURE (Check alt appropriate boxes) 0 Fun Contain ( 3LS i Tent 0 DEP V on F par G~—DE9, c=L~c tract proaceT 30_ LOCATIONS OF ARATE1APNT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e 9- eetirm. Best wing, mom S. (04 PAS Lgpiig. ceiling. plenum c0.a. running Owe, insisting +fre apr nide+s. na 1st Entire All Surfaces 6,000 ACM/Debris Clean -Up 2nd Entire AN Surfaces 6,000 (as per WTC-LB LYC-DEP 3rd Entire Alt Surfaces 6,000 Contract Procedures) 4th Entire All Surfaces 6,000 5th Entire All Surfaces 6,000 8th Entire Alt Surfaces 6,000 7th Entire All Surfaces 6,000 8th Entire All Surfaces 6,000 9th Entire Alt Surfaces 6.000 10th Entire All Surfacers 6.000 ~-~ 11 124; En+1x r 'e ;it Burt aces 31. !-hereby declare trust the information provided herein is true and cc he ' T`'s`~` of my knowledge. I am familiar with Federal, State and NYC caws and regulations applicable to asbestos related work.

JLC Environmental Cons., inc. ETS Contracting, Inc. ETS Contracting, Inc. Pratt Nine of Air Montr f~fhft Nwe of Aebeetea Conbtclor Print Name of AOai snt (!f atlter than Owner)

sipaaue Signature signature

vase 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

,C) 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 herein.

Fitt Name of owner $igntture tie

A STAMPED COPY OP THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SiTE. Any bon of' rotation provloed on this form must reported immediately to the DEP ACP The requirements of the Asbestos Control Program Rules may riot be lawfully avoided or lossened the performance of work In Incremental or piecemeal fashion. , ago+

NYC-WTC 000102603

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NYC-WTC_000102603Source: NYC Law Department, mirrored locally

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