Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

ASBESTOS C?ION REPORT (continued)

26. Asbestos Hauler E51 N4 NYS DEC Permit # N1462 —_ Tel.af C'1( ) 522_2263

Disposal Site(s) QUt: 2t 0~~ l.A►JD FI u -- PC BL~x 399 ScvrS DA~C — ~A t T 2-5~_ --

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) ❑ Fireproofing Replacement f) ❑ Other (Describe) _-- ---_--- --

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent 0 DEP Variance Application ~•lC/t''► nn I r%t1 ATIA►Ie AG AOATGIACKIT ennF ►A s•rEQ.tAL : Q. OP tvtE7N8P~P.Nc ~~/((JQ„

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 N. (e.g. Pipe lagging, ceiling, plenum FEET FEET removing and replacing boilers. etc.) boiler room, lobby. etc) ducts, storage tanks, decking, etc.)

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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.

taaaFfy 4 ?ANzee ENEarIJES _ L Q 2aA1.1 4 SON _ Print Name of Air Monitor Print Name of Asbestos Contractor Print Name of Applicant (If other than Owner)

fly-- _.~ — Signature Signature Signature

cl-oe-o2 x(-08-02 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 in accordance with the Asbestos Control Program Rules. I have contracted the third party air the asbestos abatement activities 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. _ NVC_DeT~ t~c_B-y2 _ Signature Date Print Name of Owner AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE directly to the NYC DEP ACP11 [ Any modification of information provided on this form must be reported immediately in writing lawfully avoided or lessened The requirements of the Asbestos Control Program Rules may not be through the performance of work in incremental or piecemeal fashion. ACoot

NYC-WTC 000111357