Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

ASBES INSsPECTION REPORT (continued)

26. Asbestos Hauler I E511 _ N 4 --_—__ _ NYS DEC Permit # N.l -4 62-- _ Tel.# ( it 8) 522- 2263

Disposal Site(s) BL 2A D6 E LA ND Ft LL PO e0K 399 SMTSDALE PA t'T 2 S4 _

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) , a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) 0 Other (Describe) _—M----- ----_---_--------

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

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

in f ArATIANS OF ARATFMFNT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts, storage tanks, decking, etc.) FEET ' FEET removing and replacing boilers, etc.)

ROOF QC0F S FACE 2S22

~C3A~ClG ROOF S.J A..CE 128 ME 7>.` i A/C un. rrS 1000

FKyADE EAST r-A CADE FACAOE SueFOC.E 2£330 wGST Fs%.c Q FACE. ¢G'ACE.- 2340

Fte.E APE s 300 FLL C Pt pt Soo

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.

f lWAW2,e 1 ~A N 2C2 ENf, t N fCS _B , tkt BA 1,1 SUN CGU`TZLI_ Pr t Name of Air Monitor Pri ame of bestos Contractor Print Name of Applicant (It other than Owner)

/ Signature Sig ature Signature

C-C O.2 c'9--CS-o2 --- Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance party air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized filing of this notification for the work specified herein. — C1J1t)SIo2 —> MSA~— Date Print Name of Owner Signature

WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE directly to the NYC DEP ACP. I' Aoy modification of information provided on this form must be reported immediately in writing lessened The requirements of the Asbestos Control Program Rules may not be lawfully avoided or 'cP7 through the performance of work in incremental or piecemeal fashion. ?/loo t

NYC-WTC 000111363