Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IE51 NL NYS DEC Permit # 462 - Tel.# (1t13a 522-2263

Disposal Site(s) r3it; `E 2t o4,e LAa2 rF%LL Po Box 399 S cOI _Pa 17254. —_

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildingsr ° . , ";' a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) I I Other (Describe) _—_-----N---~_—~N__ --_

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent ❑ DEP Variance Application

A 1 A/^ ATIAWC ^C A0ATGrIAGMT

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, installing fire sprinklers. (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum boiler room, lobby. etc) ducts, storage tanks, decking. etc.) FEET ' FEET removing and replacing boilers. etc.) d4 FAc.rapE 3Q FACE'S r ecs of NofztN Focv aE FP .*.oE Sat:-acs 6000

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.

rJ @12EN 4 PA RS 3. KUR213&*;+ < Sot.1 2C64TTTCL INC, Print Name of Air Monitor Print ame of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

7— c 2. 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 party 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. l9 -c 2 Signature Date Print Name of Owner

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

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. ACP7 22001

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NYC-WTC 000111244