Asbestos project notification form, February 2003

NYC 9/11 Public Portal Document

FEB. 26. 2003 5:28PM ETS INC. NO. 540 P. 3 ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler Tri-State Transfer NYS DEC Permit S 1A-375 Tel,#f (718) 617-0661 Disposal $j {5) 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 *fling of :his form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Soifer Replacement c) ❑ Sprinkler Replacement d) ❑ RenovaticnIAlterration a) 0 Fireproofing Replacement t) 0 Other (Describe) ACM Removal

28. TYPE OF ABATEMENT (Check all appropriate boxes) © Removal ❑ Enclosure ❑ Encapsulation ❑ Repair Q peen up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) Full Contral 0 Variance A~ on (as per D , G6L BP contract ps ur8s 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (5.5. enwe. easewng, roan th (e.4. Pipe ieH8U9. servo, plenum SQUARS UiSA (e g. ruw+(nB cattle. Insts~lg fire sprinklers.. _____ bollar roan aroma 1st Entire All Surfaces 6,000 ACM/Debris Clean -Up 2nd Entire All Surfaces 6,000 (as per WTC-LBP; NYC-DEP 3rd Entire All Surfaces 6,000 Contract Procedures) 4th Entire All Surfaces 6,000 5th Entire All Surfaces 6„000 6th Entire All Surfaces 6,000 7th Entire All Surfaces 6,000 8th Entire All Surfaces 6.000 8th Entire All Surfaces 6,000 10th Entire All Surfaces 6.000 1 Entire A bus aces 1 h Entire r 31, 1 hereby declar=e thatthe 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 words.

JLC Environmental Cons., Inc. ETS Contracting, Inc. ETS Contracting, inc. PMt Nerve of Air WOOF PrUt Name of Aa am Corsrnaeoor Frbt Name of Applicam(If o5 er then ownart

5 Stun Slgnsarre aioneaire

Dave Date 32. t understand that as the owner of a building where asbestos abatement activity occurs, i am responsible for the performance of ,O__monitor the asbestos abatement activities In accordance with the Asbestos Control Program Ruses. I have contracted the third party air who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorised the tiling of this notification for the work specified herein.

Knit Name d r ,mar $lgnawre Oem A STAMPED COPY OF THiS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SiTE. ification of information provided or this rm must be reported immed1etel'in writing directly to the NYC OEP ACP. me requirements Of the Asbestos Control Program Pthes may not be lawfully 3V01dod or lssa nod throuoh the oerformance of woith incremental or picemel fashion. ACPr 25501

NYC-WTC 000102618