164 WILLIAM STREET; 1001282, 93/24

NYC 9/11 Public Portal Document

164 wiu-I. m ST E. r / ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 • Tet.lt (718) 522-2263 w Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254

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

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑DEP Variance Application

30. LOCATIONS OF ABATEMENT ROOF MAT 3 Ut t_. % &CC £4 a 2.a.s DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DES&QN OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g mere. east wing, room a. (e.g Pipe lagging. coiling. plenum SQUARE LINEAR PERFORMED (e 9 rumsm9 r laci b fire . etc.)lrs. boiler room. etc ducts. tanks. de0k' .etc. FEET FEET removing and boilers. etc. 2110 F1. SCE BAC.1 ocs' Si-%eA ►orc A50 Mm Fi,ues /A/c ouc r 19ob is 5 1 1, tT W Aw 4 cwoa s;: ca 2 too __ EAST S 1500

__ t_____ ______ __ __ ________

___ ________ __________ ___ ___ I __________

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.

Print Name Monitor Para Name of Pactor of Applicant (M PrintName othor than owner) --

- --- Signature --- --------- Signature ---

_ t0t28t02 ,01261o2.

32. 1 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 monitor who Is completely independent of all parties involved in the a contracted the third party air stos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. II NiCOEP 10126 Lcaz. Print Name of Owner Sim Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. LAny modification of information piovlded on this form must be reported immediately in wrltlnq dlrecflv 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 p.ecemeal fashion. I A 212001

NYC-WTC 000110914