Asbestos Project Notification form, Corona NY

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) •-- *

26. Asbestos Hauler t ES %. N Y NHS DEC Permit # _L1 4 62 Tel.# (l tS) s22_ 226.3

Disposal Site(s) Bwe.2t ~6E ~t LANoo tL- PO box 3139 5 __t12 54

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) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) 0 Fireproofing Replacement f) ❑ Other (Describe) -----_------,--

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

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

ou. tW....... on n/AT1nk1C nC ....... ........ AQATC11ACk1T ~...~... 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 boiler room, lobb , etc) ducts, stora a tanks, deckin , etc.) FEET ' removing and re lacin boilers, etc.

i 1430

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41 d.LJAI _ _4 Gs 300

u 5SGt2 f:rz4N ; 30

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 regulations applicable to asbestos related work.

IUReCE- rl Q ?zt-R Eti6lNt Rs 13cu~Anlru ~L _ SSc_J t.niia1-et- _ Print Name of Air Monitor Print Nang of Asbest actor Print Name of Applicant (if other than Owner)

tr -i- Signature ' Signat re Signature

O$-lo_l02 Cf31~2 (02 _ __ 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 third party air asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the the have authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I filing of this notification for the work specified herein. i_ a8 2102 _ _ NYCOEP Signature Date Print Name of Owner AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE Anymodificationofinformationprovidedonthisformmustbereportedimmediatelyinwritingdirectly to the NYC DEP ACP. 1 avoided or lessened The requirements of the Asbestos Control Program Rules may not be lawfully through the performance of work in incremental or piecemeal fashion. ACPT v2oo1

NYC-WTC 000111236