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Asbestos project notification form, Zone I Originals

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NYC DEP Asbestos Project Notification form submitted for abatement activities in Zone I.

NYC-WTC_000111109–000111113

Folder label: “Zone I Originals

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Scanned page image, NYC-WTC_000111110
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NYC 9/11 Public Portal Document nt ed PUnresce wwe ote Wet ew ewven 44 56a owe ot « “yy ASBESTOS INSPECTION REPORT (continued) " 26. Asbestos Hauler _. OF nyo NYS DEC Permit ar Tel go> -272~386? Olsposal Site(e) Soolu ek i l E g hen i= ° 7 ft ef F i wires filing of this form with NYC Oepertment of Bulidings) «) 0) Renovation/Akeration alee 27. This asbestos abatement Is part of 6 (Item a through e req a) (J) demotition b) O Botter Replacement ¢) Oo Sprinkler Replacement e) 0 Fireproofing Replacement 4 D0 other (Describe) 28. TYPE OF ABATEMENT (Check all appropriate boxes) Wasemevd CLenqopure (3 Encapgutation OO Renair_ , C1 ctean up — . oy OR GE ra eramsrses 29. ABATEMENT PROCEOURE (Check all appropriate boxes) CD Fult Containment OC) ciovebeg () tent Cl vee Variance Application TZ | ~- (006 Hur 40. LOCATIONS OF ABATEMENT. Se eT DESCRIBE SECTION | AFFECTED SURFACES AMOUNT OF ACM ‘DESCRIPTION OF WORK BEING | Floor(s) FFLOOR CONTAINING ACM oe 9, Pice eggi L psquane = WEAR | eg. ble, fre sorinuters, nasa nithe mons. | ga.reamoncomperes| Vieer Wiebe | “Sarmmasetenetntes a Ee 2 si loge 4 le PERE 31. [hereby declare that the Information provided herein is true and complete to the best of my knowledge. | am familar with Federal, State and NYC laws and regulations epplicadle to asbestos related wark. ——" mae Facsun € Bu ntated Hlhgey ( oSiA Aid fren Cesiz Pan Name gt Asbestos Contractor Print Name of App! Cand Pant i } te . CinLG ae Signeture nature OO \0Z-02, | _ G-3-0 G+ 3-02 ~~ Dats Bate Sate 32. tunderstand that as the owner of a bullding where asbestos abatement activity occurs, | am responsible for the performance of ca wih the Asbestos Control Program Rules. | have contracted the third party air the asbestes abatement activities in accordan ‘ monitor who is completely independent af all parties involved in the asbestos project. | heraby dectare that | have authorized the filing of this ~p for the work specified herein. Oate AT THE WORK SITE. Print Name of Owner 4 Signature : A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE in writing directly to the NYC OEP ACP. Any modification of information provided on thi form must be reported immedia The requirements the Asbestas Control Program Rules may nol be lawtully avolded or lessened through the performance of work in Incremental of piecemeal fashion. ae) NYC-WTC_000111110

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NYC-WTC_000111110Source: NYC Law Department, mirrored locally

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