Asbestos Project Notification form, Nassau Street

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NYC DEP Asbestos Project Notification form for facility at Nassau Street.

NYC-WTC_000111346–000111373

Folder label: “Zone I Copies”

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NYC 9/11 Public Portal Document ASBESIOS INSPECTION REPORT (continued) 26. Asbestos Hauler _LESL, NY NYS DECPermit# _NJ-462__ Tel.#_(118) $22-2263 Disposal Site(s) BWE RIDGE LANDFILL PO BOX 399 SCOTSDALE PA 17254 27. This asbestos abatement is part of a (ltem a through e requires filing of this form with NYC Department of Buildings) a) • Demolition b) • Boiler Replacement c) L Sprinkler Replacement a) MRenovation/Alteration e) • Fireproofing Replacement n Ll Other (Describe) 28. TYPE OF ABATEMENT (Check all appropriate boxes) • Removal • Enclosure •Encapsulation Repair X Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) • Full Containment • Glovebag • Tent • DEP Variance Application §TAR Floor(s) 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION OF FLOOR (e.g. entire, east wing, room #. boiler room.lobby, etc) IBUCK GRNEL/BUCK TAR AND GUTIERS ROOF MATERIAL : GRAVEL AFFECTED SURFACES AMOUNT OF ACM CONTAINING ACM (e.g. Pipe lagging. ceiling, plenum SECARE AERE FEFT• ducts, storage lanks, decking, etc.) UPPER ROOF ROOF SURFACE HC UNITS É METAL MAIN Rof ROOF SURFACE METAL SURFACES SUZPACE/LiALL MAIDEN LANE SIDE suRracE E ArC R00F SURFRCE / PARAPET GaCLA STREET SIDE WAU S METAL FACADÉ INTERIOR FACADE SURFACE FACADE SURFACE FACADE SURDACE FACADE SURFACE 4205 800 8847 1000 2424 1634 4840 6716 4240 12200 TRu 1291 Mu02 DESCRIPTION OF WORK BEING PERFORMED .g. running cable, installing fire sprinkle emoving and replacing boilers, etc INCLUDES BULKHEAD ROOF MAIDEN LANE SETBACK Geco Steeer SerBcK GOLO STREET MAIDEN LANE 31. I hereby declare thai 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. WARREN PANZER ENGINEERS Print Name of Air Monitor B. KUEZBAN & SON CONTROL Print Name of Asbeslos Coptractor Mux Print Name of Applicant (If other than Owner) Signature oglizloz Date Signature 08 |1zloz Date Signature Date 32. I understand that as the owner of a building where asbestos abatement activity occurs, l 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 asbeslos project. I hereby declare that 1 have authorized the Btentot "NYCDEP 08/12/oz Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Any modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. 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 ACPT, NYC-WTC_000111359

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NYC-WTC_000111359Source: NYC Law Department, mirrored locally

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