164 WILLIAM STREET; 1001282, 93/24

NYC 9/11 Public Portal Document _ YT

2t Aeeeelioe ffauler _Cos_I, tai43 NYS DEC PemNt LLt - 4t ToL 111_ a Disposal Site(s) EWERt DGc ta►aoFi Lt. Po Box 399 s t~neso s 'a, L 'r

27. This asbestos abatement Is part of a (item a through o requires flNng of this form with NYC Department of BuIl ) • a) ❑ DemolitIon b) ❑ Bolter Replacement c) ❑ Sprinkler Replacement . d) ❑ Ranovatk nJAlteratbrt e) ❑ Fireproofing Replacement f) ❑ 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 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 iMng. room p. (e.g. Pipe tagging. ceiling. piernan SQUARE LINEAR (e.g. running cable. Installing flee sprinklers, haler room. lobby. etc) duds. storace tanks dedikicetc. FEE? ' FEET removi and egiac1sig boilers. etc.)

FAcn os= w ~' ca E S cE. 1430 % Ca 1 200

" I Au:t m s W G 30c' t+ setae na-ot t T 300

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.

ll a2C4"1J ~RNrrsR E~6 ~ IKu.AM~a a:CtBiW t stt: __ Pint Name of Air Monitor PrintNero! of Asbes toe Print Mane of Apaticant of over than Owner)

~r Spne ~w t~fre ~ S9 nature — -- S 9natae

Ct3j l02- ct+1~2 (02 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 parr, 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. _ Nteot~ rt3~~2~02 — Print Name of Owner Si tore oate

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 ttsrbuoh the performance of work in incremental or piecemeal fashion. I ,ter v"ot

NYC-WTC 000110918