Asbestos work schedule and permit application, Oct 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler test. NY NYS (DEC Permit # W-)- 462 Tel.# C'116) 522-2263 Disposal Site(s) _ 8we. w D4 LAID F(t.%. P o Box • 399 S eoTS OAt - 1?A I T2s4

27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement 1) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ~~ w~~ ❑ Full Containment ❑ Glovebag 0 Tent ❑ DEP 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 N. (e g. Pipe legging. c eang, plenum SQUARE LINEAR (e g. naming cable. tang the sprinklers, bo5w room etc) duct.. storage lanks. dedir..eta FEET - FEET removing and elm) _A"DE icAST VACq UP-McES 4050

11 WEST FACADE S re.c S III 2 S a. Ft _sco vas 4400 RooF RooF SUeFAc.E 6O8 UP.Oe WATC-a. Toc R t.ARi.E -BACK ROOF SUQFACe 444 Utz .rt Flo gS'F PE $Mall set- Bete RooF 5ueFAC.E 150 t.Ae4e srtaAcu W pr." Su2Fs*C 200

31. 1 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 ae PANZER EN61NEEeS 8. 2e eit Soak CONT2ot. INC. Print Name of Air Monitor ix Name be Contractor Print Name of Appcant (If other'than Owner)

Signature e Ignature signature

10 t09t02. (0109 102 Data 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. NYC DEP to l 091oz Print.Name of Owner signadue Dele

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 wilting 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. I As a2001

NYC-WTC 000110814