WTC document identifier, 3 World Financial Center

NYC 9/11 Public Portal Document

-1-

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler Tri-State Transfer NYS DEC Permit # 1A-375 Tel.# 718-617-0771 Disposal Site(s) Meadowfill Landfill, Rt. 2, Box 68, Bridgeport, WV & Greenridge Recalm., Rd. 1, Scottdale, PA__ 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) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) ❑✓ Other (Describe) ACM Removal Only

28. TYPE OF ABATEMENT (Check all appropriate boxes) 2 Removal 0 Enclosure 0 Encapsulation 0 Repair El Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) El Full Containment 0 Glovebag 0 Tent 0 DEP Variance Application '(I3Ht) 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING CONTAINING ACM PERFORMED (e.g. entire, east wing, room li, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR boiler room, lobby, etc) (e.g. running cable, installing fire sprinklers, ducts, storage tanks, decking, etc.) FEET FEET removing and replacing boilers. etc.) 1st S.E. Corner Debris Clean -Up 1,300 ACM Debris Clean - Up 2nd S.E. Corner Debris Clean -Up 4,000 ACM Debris Clean - Up Mezzan. S.E. Corner Debirs Clean - Up 4,000 ACM Debris Clean - Up 3rd Training Room Debris Clean - Up 1,200 ACM Debris Clean - Up 3rd AC Unit, AC 2C Debris Clean -Up 800 ACM Debris Clean - Up

Note: Above areas to be abated as per World Trade Center Protocol Letter of Work Procedures For Debris Clean Up.

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.

A ient Gro , Inc Contracting Inc. ETS C ntr cting n . ______________________

j Print ne f nitor meo Os Co Pri a of Ap (If other than Owner)

S' natu Signature Signature 12/5/01 12/5/01 _ _— 12/5/01 Date Date Oate 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 filing of this notification for the work specified herein. project. I reby declare that I have authorized the _ American Express Co. -^__ _ _ _ _ 12/5/01 Print Name of Owner Sig ature Date (as agent for owner) l 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 through the performance of work in incremental or niecemeal fachinn ACP7 212001

NYC-WTC 000110955