Asbestos Project Notification Form, DEP Box 39

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler JESL__ NY _ __ NYS DEC Permit # b-1 462- _ Tel.# C11 tj32-2 26.3

Disposal Site(s) 131 sir CLIP ,E Lo N01_It PO Sax 399 Sco'r5 ~±L.E pA (T 2S4

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) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) 0 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 ❑ Tent ❑ DEP Variance Application - 30 LOCATIONS OF ABATEMENT , DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM fIPTION OF WO K BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR ning cable, installing fire sprinklers, (e.g. entire, east wing, room N. FEET boiler room, lobby, etc) ducts, storage tanks, decking. etc.) FEET ' removing and replacing toilers, etc.)

i'AC.ADE SOVTt4 54Eo0

FACADE So,_ (tuSto~) 28 276 fACADF. Noe 20000

FA4ADE. I As'c tSoc>C3

FAcA D. tt.eST ii TOv FLUE (Jive c ' 2400

Flee E:SCAP€c5 16S0 Duct i;PO K 4 A/C.. el3l IS 960 5e•T 1i 25

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.

j)/ tA Print N e of Air Mon' r Prin Name Asbesto ontractc,r Print Name of Applicant (If other than Owner)

Signature Signature

SignatureeT ~1 — Date -- Gate Oate

32 I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance of air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party 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. + o I041o2 Signature Date Print Name of Owner SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK ACP. Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP rements of the Asbestos Control Program Rules may not be lawfully avoided or ACP) 2!001

NYC-WTC 000111290