130 WILLIAM STREET; 1001187, 77/15

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 1 30 l wL-u.Atv1 S' t- -t 26. Asbestos Hauler IESI,NY — NYS DEC Permit # NJ-462 Tel.# (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ RenovatioNAlteration e) ❑ Fireproofing Replacement f) 0 Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING 76 o~ Floor(s) OF FLOOR CONTAINING ACM (e g entire, east wing, room S. SQUARE LINEAR PERFORMED (e g Pipe tagging, ceding, plenum (e g running cable, installing fire sprinklers, boiler room, boo . etc) ducts, storage tanks. dedun . etc) FEET FEET removing and eplaang lacing boilers etc Zap FL Si ir BAC 4040 3 p0 FL t' II 375 FL I t I 1 375

tuna A. It t' 375 ZNoP stT13f .je LtiM4 S 24;i -e. ISoo F~CAOE Srxs;141 FACAD —D6~c5 ri I`t it FAST FACAVe it .t 6105 e Sc ~►c.i= 11bg2

31. I hereby declare that the 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 work.

U '~33 5 1132ER +q S— ku- _CT~.OL - _ Print Name of Air Monitor Pn t tame of A St Contractor Print Name of Applicant (If other than Owner)

-------- ----- --- --- ---- Signature Signature Signature

10124 I0Z. - ------ 10124102- --- Date Date ------- -- — Date

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 monitor who is completely independent of all parties involved in asbes os project. I hereby declare that I have authorized the filing of this notification for the work specified herein. 1 Print Name of Owner tvyc.D P (0 I24 Signature )o2. Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. ,,LAnv modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or ACP7 211001

NYC-WTC 000110473