164 WILLIAM STREET; 1001282, 93/24

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) --.

26. Asbestos Hauler IRS %, t' NYS DEC Permit #_k) -4 62 Tel.# ('1%&) 922-2263

Disposal Sites) Met orac~ 1ANo ct u.. PO BOX 399 5 coo is pA PA !?2S4

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement 4 ❑ 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 en LVVL..VaV f A/'ATtf%MQ AG V. Al2ATGLICMT r..rr.. w..-.... .7v.

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. cable, ling sprinklers, (e.g. entire, east wing, room lf, (e.g. Pipe lagging, fi g. plenum U FE FEET N re~ fi boiler room. . etc) ducts, tanks, decking. eta

fAC DE Wz_ CAna 5 .E 1430 cis CA' 200

N a•wNt MG 3tXs

a S roams ANT 300

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.

WAeeiahl Q ?l sz € it3E_ s 8ra"~AM'is k!&ZeA► 4S"t4 NiP_cl Print Name of Air Monitor Print N of Asbes actor Print Name of Applicant (if other than Owner)

Signet re Signature Signature

08Z102 Cal r' 2 `O2- Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third 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. e1 ( lf'tC0 a81o2102 signature Date Prim Name of Owner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE writing directly to the NYC DEP ACP. [Any modification of information provided on this form must be reported immediately In or lessened The requirements of the Asbestos Control Program Rules may not be lawfully avoided through the performance of work in incremental or piecemeal fashion. Ate ?/2001

NYC-WTC 000110925