Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

i- . ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler .J E5 N~ _ NYS DEC Permit # NJ-462 __ Tel.# CT (fi) 522 -

Disposal Site(s) _Blue 2tP6E LAD FiLL PO BOX 399 SCoTsc>A Lr-- PA, 1T2S4 _~_

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 f) ❑ Other (Describe) -------------------------

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

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

30. LOCATIONS OF ABATEMENT t2aoF ►.1ATwIzb4A% : hoot= f, w1`!-e E (T~`Q-) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room N. (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.)

FA<2ADE NCP_7lt (JOHN ST) GA co. DE Su2Ga.rES 2530

s o u ibt t%A-r .o ~E SJ Q GA.c.ES ?-SOS GIZGJ►3D 6.2 -CA..€ Ca 20~JWIJ I .t o 35S fzooF p t-, s` Qoop Root' 5 10

0-d P-cool Seer,=mac l 50 fACAOC- I u:csr 4565 it I ~AsT GfA of SJCI=/ma`C Piw e- _ 1763 W ES'r W QS r U ' .2.D 5 cr.J_TYi) IPA¢sP~r we. U'~+'— Aar Fa_OY'C (T60 CAST I Fts.Or2. Are. . CrwP.rYARQI u s~..ms cis. yaao e,votz tog 6^ceora4 Z..A Go Ir ANo GwrcclEl+ Owe~otT P AD S1ZCr4~S

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.

PAN2c2 ENC.INtcE Z$JA.M I N kt.lR 2eAti 1 SON Cctire Print Name of Air Monitor Prin Name of Asbesto Contractor Print Name of Applicant (It other than Owner)

Signature Signature Signature

CEtt6-1102 og10-r tat __ 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 the asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein. ' —bep oB IOT (02 Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

An modification of information rovided on this form must be re orted immediate) in writin direct) to the NYC DEP ACID. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the erformance of work in incremental or iecemeal fashion. ACP1' 22001

NYC-WTC 000111349