Asbestos Project Notification Form, Corona NY

NYC 9/11 Public Portal Document DEP ECB Fax:212-361-1433 Jun 28 2002 11:26 P.07

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler ~ f) _ NYS DEC Permit CTØ1,3__ Tel. 8z> ^ Z72' .3c 7

Disposal Site(s) e2 N l~ le 5 , F - 27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) s) ❑ Demolition b) ❑ Boder Replacement c) 0 Sprinkler Replacement d) ❑ Renovation/A!teration e) 0 Fireproofing Replacement f) ❑ Other (Describe) —_ — ------

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) G] Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application vvn ,V lv DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTI N OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. enire, sail rrkig, room 8. (eq. Pipe Isgghg, casing, plenum SQUARE LINEAR (a,g. alas, installing foe spOkklers, running PUT • FEET e ackv boaan ate. ooarrom. Ioev. 5c) u ti ator a tanks e.ctcinc l

familiar with Federal. 31 I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am State and NYC laws and reoulations sooiicable to asbestos related work.

Pdnt N lux Pri Nam* As aloe Contractor Print Nam of Ap t (M othee then Owner) }~

.~ Sgnttura Signature nature

Ost Oats 0*15 for the performance of 32. I understand that ~ the owner of a building where asbestos abatement activity occurs. i em responsiblecontracted the third party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have asbestos project. I hereby declare that I have authorized the monitor who is completely independent of all parties involved in the filing of Ificatlo for the work specified herein —

— —L & — bate Print Ns at — 3~nelur a AT THE WORK SITE. A STAMPED CO Y OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE directlY to the NYC CEP ACP. Any modification of info ati n rovlded on this form must be reported Imrnediatey In writing avoided or lessened The require ants of the Asbestos Control Program Rules may not be lawfully fashion. through the performance of work in incremental or piecemeal v2oot

NYC-WTC 000111161