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Asbestos project notification form, 30 West Broadway, Aug 2002

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Asbestos Project Notification form for an inspection at 30 West Broadway submitted to the NYC Department of Environmental Protection.

NYC-WTC_000109848–000109853

Folder label: “30 WEST BROADWAY; 1001414, 127/11

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NYC 9/11 Public Portal Document a 24 . Met ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler t > b \, Cogpwo NYS DEC Pemit# CT“OTR ter : &a7 Disposal Site(s) Soath ekRp HH (E % hen 125 / tz ef Cah will = Ge . os 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) “3 oe “ € ry a Renovation/Alteration:~ 7 - a) L) Demotition b) 28. TYPE OF ABATEMENT (Check all appropriate boxes) O Removal Enclosure Boiler Replacement e) O Fireproofing Replacement i) O Other (Describe) c) O Sprinkler Replacement . Encapsulation O Repair w Clean up er. 29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Fur Containment oO Glovebag O tent OO vee 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 #, (e.9. Pipe tagging, ceiling, plenum | SQUARE LINEAR (e.9. running cable, installing fire sprinklers, boiler room, tobby, etc) __ ducts, slorage tanks, decking, ete.) | FEET FEET removing and replacing boilers, etc.) Root | As Puae + 30d Litt | SETeAcK + CRaver AMopo | | ISt# | SetbLachy 4 Crouse) RAO (V4 | Set back. 4 Crow 2 2-2, FOD 4 q 4os ev Ul Facdoe Qe? 12,00 Q¢ 1 31. (hereby declare that the information provided herein is true and complete to the best of my knowledge. | am familiar with Federal, State and NYC laws and regulations applicable to asbestos related work. Fxcun CxGueninee| folfony Costa | Adlhai Cosa a Pant N; itor Prin Name fi Contractor Print Name of Appicant (If other than Owner) ignature nature 0G-\OZ-02. 6-3-0? ~ Date Oate 32. t understand that as the owner of a building where asbestos abatement activity occurs, | am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. { have contracted the third party air “ » Monitoc who is completely independent of all parties involved in the asbesto: S$ project. | hereby declare that | have authorized the nt. filing ofthis notification for the work specified herei ded eee | ee .. “Pral Name of Owker * Signature Oate h Stimpen COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Fy, Pegi : ee AY madification of information rovided on this form must be reported immediately in writing directly to the NYC DEP ACP. . ne requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ae through the performance of work in incremental or piecemeal fashion. NYC-WTC_000109849 acer 272001 A

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NYC-WTC_000109849Source: NYC Law Department, mirrored locally

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