Facsimile transmission cover page, Oct 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler 1E5t1 $3 Y NYS DEC Permit # • Q62 Tel.# (.116) .522— 2263

Disposal Site(s) eLL* V-4D6E tAUOFfts. PO 8oX 3,0 SGo't5V#t SPA tl'ZS4;. ` M

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

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ 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, roan!!. (e.g. Poe lagging. ceding, plenum SQUARE UNEAR (e.g. running cable. Installing fire sprinklers. boiler room. loboy, etc) ducts. storage tanks . etc.) FEET ' FEET removing and replacing bodes etc.

2ooF Lttd►it QooF 6 2~8 in LOU.) tRooF .SQe*s& E e6IT

2( sr agr- 13o c.s 0GoF- sv 610 L T%L it Poo 1420 t5tu It — 1S20 12TU tt RAOF 5u¢.Fierc`e 2448

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.

WA0 4 PA.tszee witlllc '$. k awN 4 Sou dotisrnot_ Print Name of Applicant (If other than Owner) Print Name of Air __toe Print Nat f Ast>ast tlhtrectar

/t Signature L. ~ N11 Signature 11 Signature

IOL o3(O2 10(03102. 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 asbe tos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. ~+YCOrcp toIzfl[3102 _ • Print Name of Owner Signature Date

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

I_'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. 2rxoot

NYC-WTC 000110826