Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler ASBESTOSTRANS. CO. .NYS DEC Permit # 1A-371__ Tel.# (631) 924-5050 Disposal Site(s) IMPERIAL P.O.47, 11_BOGGS RD., PA / SOUTHERN ALLEGHENIES_VALLEYVIEW DR., PA_

27. This asbestos abatement is part of a (Item a through a 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) 0 Removal 0 Enclosure 0 Encapsulation 0 Repair 0 Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑DEP Variance Application 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM Floor(s) OF FLOOR DESCRIPTION OF WORK BEING 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, decMnp, etc.l FEET FEET removing and replacing boiler etc.) ROOF- 5th FLOOR SETBACK ROOF, DUNNAGE, DUCTS 1,940 ITEM #2 ROOF PENTHOUSE ROOF, LOUVERS 2,000 ITEM #2

31. 1 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.

WARREN & PANZER ENG. P.C. TRIO ASBESTOS REM. CORP. _ NY Print Name of Air Monitor Print Name of Asbestos Contractor Pr are of I r than Owner)

Signature S ature Sig aturs

C) aro-_ Date --- Date z.... --- -- - -- _

II j c J ,

a

Date -`-

32. I understand that as the owner of a building where asbestos abatemen c vity o urs, am responsible for the performance of the asbestos abatement activities in accordance with the As stos C tro Pro . I have contracted the third party air monitor who is completely independent of all parties involv in t be )ect. I ereby declare that I have authorized the filing of this notification for the work specified herein. FINANCIAL DISTRICT ASSOCIATES LLC _ _

Print Name of Owner Signature r Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Any modification of information provided on this form must be reported Immediately in writing directly to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened throw h the performance of work in incremental or piecemeal fashion. ACP>• V2001

NYC-WTC 000111377