Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler _1 E5L. NY _-- ----_ Tel ft L'l1S) S22 - 226 3 - NYS DEC Permit # N.) - 4 6 2 --_ : Disposal Site(s) C Lie ¢~D6E Dcl~ PO BOX— 99 — SaorrsvA•~.a PA— 17254 f

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 t) 0 Other (Describe) _------_ — — —_----------

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

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

30 LOCATIONS OF ABATEMENT 90OF MATt<R' A& ' QAOF MEMBRANE (TAR 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 FEET . FEET removing and re lacin boilers, etc. boiler room, lobb , etc) ducts, store a tanks, decki , etc.)

2ooF ROOF SvR-F~.~E TISS Ate ROOF Surua►cES

Buy< t.tE 1092

-r PAeAPt 123'C

h!C 4 t )C.i S 1900 ►rte

fiQE esC`Am c C.*AE 450

ItaTE -40R- IICAOES 6590

11 WeST e-2/ Sxaorkc.E 2730

4 No Wl *c-E

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

WAPo_oJ ~t ANZER C1Y~,1►1EERS . iGu¢ZBAN Sot C&SITRcL Print Name of Air Monitor ., Pri Name of Asbestos Contractor Print Name of Applicant (if other than Owner)

Signature Signature Signature

- ti -(.l -o2. Date Date Date

performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the Control Program Rules. I have contracted the third party air the asbestos abatement activities in accordance with the Asbestos authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. WIt016P Signature Date Print Name of O ner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE the NYC DEP ACPIII 1 Anv modification of information provided on this form must be reported immediately in writing directly to lessened The requirements of the Asbestos Control Program Rules may not be lawfully avoided or through the performance of work in incremental or piecemeal fashion. Acpl 2/2001

NYC-WTC 000111252