Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler II €Si,, _wt4 NYS DEC Permit # W.1 -462 __ Tel.# C•7 i 8) 522- 2263 _

Disposal Site(s) ) WE R1Q6E IANOF~tI P 060i( _C S (-E ?A 17254__

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) 0 Fireproofing Replacement f) ❑ Other (Describe)

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

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

,in 1 Ar`ATIr1NS OF ABATEMENT 0F MAT~V..tAL: P—"+OF ME MB2AI1E 7iu(/41S~Yf-/ro21Z. 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 FEET removing and replacing boilers. etc.) boiler room, lobby, etc) ducts, storage tanks, decking. etc.)

RAF pooF .su217ACXR5 1700 IIJCwoe?s McAt wt fv1A i11 aooF 20oF 5(JQ_Fs~< S C,LuDES META( 4 LEDGE

II PFuf 3St E>i. U3A4LS 3300

FACkOE SOO DOE Sc FACE X T65 a It AK ESCAPES 7400 .j t..oca~CtONs

____ West t~c'-M S css 5400

11 4~lETo~( S►itiflERS 20T00 (3oni. SII -s Sc~ M FAcloe

i' M+TAz • 77tlits F(uE 2 (OD

t Wr ear;c moF 5IJVJ CE 1200 t=aco of Face ~~ Sir.• F.keE 1200

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.

_~ A4 QC►1 'PaA 2Er_ e" I"eyes ►.t tAM I f. Vut2Z8AV1 I Sol C.OMo P ' t Name of Air Monitor Print Na a of Asbestos ntractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

09-12-02 O -(2 _02 __ Date Date Date

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. NYCDEP ~"~ -i 2—a2 Signature Date Print Name of Owner

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. DEP ACP. I Any modification of information provided on this form must be reported immediately in writing directly to the NYC The requirements of the Asbestos Control Program Rules may not be lawfully avoldea or iesseneo through the oerformance of work in incremental or piecemeal fashion. ACP7 2/2001

NYC-WTC 000111347