Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler (€55, NY NYS DEC Permit # NS - 46t Tel.# (1(t3) 522- 2263

Disposal Site(s) SLIuc ¢.IOFare LA00Flu. PO Box 399 5coi , .a PA IT254

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) 0 Other (Describe) —_

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

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

IA I A('ATIflS AF ABATFIu1FNT uc6At3Qor.1E- 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, morn #, (e.g. Pipe tagging, ceiling, plenum boiler room, lobby, etc ducts, story a tanks, dedring, etc.) FEET FEET removing and replacing boilers, etc.)

ROOF Qocc SQP_F..e 8360 I eu.O s 1Il Il IEOGF SET- B.wcrc ROOF 990 A/C UI, tTS , 'D t3CTS 4 SS00 11 MHTAL ,,;i3FAC.t!L

It PARAPET WAU.S 500

cAc .DE wEST FACAoe Suczcore 2650 if t.sT Ff+co.oc SuQFr.ce 2915 WALL ADA ACaD a To 4 W kU S CCI►C-E 560 tE It EscsEs U3Aa,t S..tsFe>,CE 4200

a Ft¢E Esce.o^Es 2cso 1► ~.warh45 ICS0

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.

kaeco~ 4 P'NzeL b4iNeges M. licuWaAN Sc* C ruo.. (uc Print Name of Air Monnitoorr Print me of Asbestos contractor Print Name of Applicant (If other than Owner)

44 Signature Signature Signature

_ 07-2-c'2 oT-2e-o2 . 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. , wr1/Co O'f-26-0 2 Signature Date Print Name of Owner

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. ACP. III An modification of information rovided on this form must be re rted immediate) in writi direct) to the NYC DEP 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. ACPM Vnoo+

NYC-WTC 000111230