Asbestos Project Notification form, Nassau Street

NYC 9/11 Public Portal Document

~ o ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler ?1~N`?--- ~~ -- _ NYS DEC Permit # I -4 4. —_ Tel.# 111g 22 -223

Disposal Site(s) BtxlEpt~G IANNpf► u PQ~O —CsDA — 2A t7 2s_

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) 0 Sprinkler Replacement d) 0 Renovation/Alteration

e) ❑ Fireproofing Replacement f) ❑ Other (Describe) — —____—----------------

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

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

nn 1 PPA1•1A►1C AC ACATCLACMT JV. _vvn I, .

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 rite spnnklers, (e g entire, east wing, room N, (e.g. Pipe lagging, ceiling, plenum FEET boiler room, lobb , etc) ducts, store a tanks, decki . etc.) FEET ' removing and re lacin boilers, etc. 510eKE BLDG toOF ~w.0

Q,OCF PF S:tR-FACTS 51'19 MA liodF I. SuA►,.L vier A'►C.KS SET SAC Rao F t2C0F S& C.es 2A50 Mena _ ?stns r-Ja-SPCE 50;-ic µQFa.as A-~ ROt',rr ( S 1GQ Lt 4 N TS IOCC

II Ducts 4 METAL. 5:1¢.r-mac 1250 $':CRAL M METAL STAIR :.ET QACYI WAu Sj¢FAeES _UT` 4870 cts u.`au5 DeGP r,.Com

FAcAt ( Wotutt 4`toou;s 1-EDC,ItS 400 M1140pu * LEDA rrS o1a LY It I SCgr}i (-JoMA S'r) FACAP __.JPEc i340 I NINCiS Sifd4S

Federal, 31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. I am familiar with State and NYC laws and regulations applicable to asbestos related work.

w cnt PPM E"IAEEV-S ~~,I:OL •QZ8P* I s Contractor 'a •• PrlrtI _ Print Name of Applicant (If other than Owner) Name Tnitor Nam of bes s

dli—t Signatu S nature Signature

— O8— - o 2 0—rS02 ---- Date -- -- Date Date

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

Signature Date Print Name of Owner AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE directly to the NYC DEP ACP. Any modification of information provided on this form must be reported immediately in writing avoided or lessened The requirements of the Asbestos Control Program Rules may not be lawfully through the performance of work in incremental or piecemeal fashion. ACP1 2/2001

NYC-WTC 000111353