156 WILLIAM STREET; 1001281, 93/20

NYC 9/11 Public Portal Document

ISs WIt_t-iA1A 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 e requires firing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration 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 ROOF IA ATE 2I AL '- s 'I>= S AtJ I) OR E RA' E L 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.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e g. running cable, installing fire sprinklers. boiler room, lobby, etc) ducts. storage tanks, decking, etc.) FEET FEET removing and reptaong boilers, etc.)

___ O~ 5t-%QFAe 888 dowuoy o` ueR fLooi SuRraCE S2S

li Mew(_ woetc 740

11 t&3luoota ( DC*E 16 >;C~EIa'TLl FL. Roof Ot= SUQFAC t= 3354 ROOF I2ooF 5va- 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.

W&POEVIt 'p&oZE z 6 ,I►3t~e5 '~, iiutczlsp SON C0Nm.cL -_ runt Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

ignatur/ Signature Signature

a6~3o__ Oi (3ote2 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. ( 30 It OZ Print Name of Owner Signature Date

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 performance of work in incremental or piecemeal fashion. „CP7 • 212001

NYC-WTC 000110727