EPA residential cleanup announcement, Lower Manhattan

NYC 9/11 Public Portal Document

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ASBESTOS INSPECTION REPORT (continued) LO p _p $per-272^3& 7 Tel. 26. Asbestos Hauler NYS DEC Permit

Disposal Site(s) U e2N i!rE to5 q,L IS'('. . 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) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application/ , I'l 33 11 3 Z.-

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. room M. (e.g. Pipe tagging. casing. plenum SQUARE LINEAR (e.g. n nning cable. installing fin sprinklers, boiler room, lobby, etc) ducts, storage tanks. deck . etc.) FEET ' FEET removing and replacing boilers, etc.)

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.

V- bSL1rr clattiLM I 5T7 C1X~ y c177i J4L)i,cd Print Nan or App .ant (If other than Owner) Prin Name r As slot Contracts

kPinc Signature z . _______

naturo Signature

Date Date clue

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 project. I hereby declare that I have authorized the Ili of this notificati for the rk specified herein. ro iL O ~#1l~'~ Print Name Owner Signature to

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

L..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. J Acv? ianot

NYC-WTC 000111079