156 WILLIAM STREET; 1001281, 93/20

NYC 9/11 Public Portal Document 15G UOILL)AM ST2Et.T ASBESTOS INSPECTION REPORT (continued) 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 a requires filing of this form with NYC Department of Build ) a) ❑ Demolition b) ❑ Boiler Replacement C) ❑ Sprinkler Replacement d) ❑ Re'novetlorVAiteratlon 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) 0 Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application 30. LOCATIONS OF ABATEMENT ROOF WATEt21AL • S'MNIGS A130 pl2 E RAv E tl_ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire. east wing, room K, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR PERFORMED mooing pare lcin installing riles, etc)ers, boiler room. lobby, etc) daces st tanks, decking, etc. FEET FEET (° r removi and r ad boilers, etc, TaP OOLDt4 o1= SuQFAC~ 8881 oUi t=R ftobF SUgF ,. 525 It METAL. WCW-K 740 It WIu0o LEOr9E 16 E''iEWT1,1 FL. Roof 5L12t=At^ F 33S.4 A. uwt' RooF Foot= Satz e- 1914

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.

I~ARQEN Pl1lTEit 6 l3cS <t)(LZBA►J 1 SON QPTY)-OL __ riot Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

ignature Signature --- -- - Signature

06 13bto2 C6 (3oIe 2. 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.

fJy~+ DEP 06 130 102 Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. II[Any modification of information provIded on this form must be reported immediately in writing directly to the NYC DEP ACP. requirements of the Asbestos Control Program Rules may not be lawfully avoided or ACP? 2x2001

NYC-WTC 000110703