Permit application or correspondence, 150 building, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler 1 E5I~NL _-- N 462 --_ —~ NYS DEC Permit # N1 Tel.#

Disposal Site(s) (3tuE AND FILL Pt) Gax 399 ScoTSDAUE 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) ❑ Renovation/Alteration

e) ❑ Fireproofing Replacement f) ❑ Other (Describe) ~-- ------------ ---

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

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

on 1 APATIAMQ n. AC AQATCMCMT .•r,.. '00F L,&Tc2.AL - - -- - - I tL.0OF - Mt=MBRAt. JV. -

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, installing fire sprinklers, (e.g entire, east wing, room p. (e.g. Pipe lagging, ceiling, plenum FEET ' FEET removing and replacing boilers, etc.) boiler room, lobby, etc) ducts, storage tanks, decking, etc.)

ROOF 5ue _Ac_E' 2T4 6 ANN Srtz~r SIDE oNL^f 20114 FL SE1 t3Ac;c set BPc.Ic Q,DF 5u2FACE (596 FULTON STMeET StOe ONLY 17T4 FL ALL S IDES C ANN C O.-D, ('3M FL $E% -BACK 6240 4.1LL I AM .2/,,•o t- ,JL7ON S T&eEr ) sET SACK- en c S 2:;Ic.c 61o._p s tv?E s i DE IOM FL SET Bp.0 set t~o.~-te RcOF 5 m4 a T80 t=~LrtN s'a. r s,DE

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.

wp,p -ew 4 PQeiw E116tNEERS -B . ILu BAN 01.3 CoaTRAL (NC. _ tint Name of Air Monitor rin Name of St Contractor Print Name of Applicant (If other than Owner)

_ti. Signatur _______

S nature -______

Signature

11-12-02 fl -1? -02 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 the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. __ft -f9.-o2 Signature Date Print Name of Owner

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

[Any 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 lessened through the erformance of work in incremental or iecemeal fashion. ACP7 2/2001

NYC-WTC 000110632