Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

t ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler __I E51 , NY __ NYS DEC Permit # w - 462_ Tel.# _C1(8) S22- 2 263 Disposal Site(s) _euk et D4 LANoFt t~ ' `P O Box 399 SC.crs Do.tu~ Pa 1?25q

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) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ Other (Describe) --------------------------

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation 0 Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT f2oc>c MnA.T>CR-rI A,.. . .00F LAEM 32A►+~ '~ /336~ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e g. entire, east wing, room IF, (e.g. Pipe tagging, 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.)

2oOF ROOF SucrFAC. 10(X) •t PA2.&c -rs 467 QU-IiEP-5 Ito 1=aC:AOES GC S..A*L4.. t3O u l C&OE 5 2345 ..»~~ (3ulte «1 o5 u a/c uwt t5 i MEX.— +_ 23T0 2rao i WlµDow LE)6ES (tO) 25th

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.

~ Qt7J PANZ4Se E_ WGii EOZS 4 Scl i QutiTp & Print Name of Ai itor Print blame of Asbestos Contractor Print Name of Applicant (If other than Owner)

gnature Signature Signature

Ot3-19-02 3. t9— 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 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 asb tos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. _YCOEP Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. A —..__ J['--•-- t_____. _ _ _ __ -._ _ _ ..... •_ __ __ ._• 4-_ ____'_ -. . . . •._._. _ _ ._. _— ~.___•.-.•— •lam ~..•~ ~—r~ •r.e~

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. ACP7 212001

NYC-WTC 000111371