NYC 9/11 Public Portal Document
(continued)
ASBESTOS INSPECTION REPORT
Tel.#Ynn_272-3867
Logano NYS DEC Permit # CT-098
26. Asbestos Hauler !~..—.
Southern Alleghenies Valley Landfill
DisposasSite(s)
with NYC Department of Buildings)
This asbestos abatement is part of a (Item a through e requires filing of this form
27. d) ❑ Renovation/Alteration
b) 0 Boiler Replacement c) ❑ Sprinkler Replacement
a) ❑ Demolition
Other (Describe)
e) ❑ Fireproofing Replacement f) 0
appropriate boxes)
28. TYPE OF ABATEMENT (Check all ❑ Clean up
❑ Removal 0 Enclosure 0 Encapsulation ❑ Repair
all appropriate boxes)
29. ABATEMENT PROCEDURE (Check
❑ Glovebag ❑ Tent 0 DEP Variance Application
❑ Full Containment
•
knowledge. I am familiar with Federal,
provided herein is true and complete to the best of my
31. I hereby declare that the information asbestos related work.
State and NYC laws and regulations applicable to
Fiber Control, Inc. Fiber Control, Inc.
A.T.C. Associates of Applicant (If other than Owner)
Print Name of Asbestos Contractor
Print Nertof Air Monitor
Signs, e
ignature
. 9/17/02
for the performance of
where asbestos abatement activity occurs, I am responsible
32. I understand that as the owner of a building with the Asbestos Control Program Rules. I have contracted the third party air
the asbestos abatement activities in accordance involved in the asbestos project. I hereby declare that I have authorized the
monitor who is completely independent of all parties
herein.
filing of this notification for the work specified
As per cleaning request form Date
Print Name of Owner Signature
SITE.
AMENDMENTS MUST BE AVAILABLE AT THE WORK
A STAMPED COPY O.F THIS FORM INCLUDING
the NYC DEP ACP.
this form must be reported immediately in writing directly to
[_Any modification of information provided on
Rules may not be lawfully avoided or lessened
The requirements of the Asbestos Control Program incremental or piecemeal fashion.
through the performance of work in ~Pot
ArC
•
NYC-WTC 000107432
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000107432Source: NYC Law Department, mirrored locally