Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) • Asbestos 26. Asbestos Hauler Transportation Co. NYS DECPermit# 1 A-371 TEL.# 631-924-5050 DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies 1 27. This asbestos abatement is part of a (Item a through e requires filing of this form with Valleyview Dr., PA NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) 0 Fireproofing Replacement I) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ 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 I DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire. east wing. room K, (e.g. Pipe SQUARE PERFORMED to lagging, ceilin9 plenum LINEAR (e.g. oving aadlr plci installing file s. nk)ers, boiler room, lobby. dc ducts, storage tanks, decking. etc. FEET FEET removing and replacing boilers, etc.) acad .Item No. 8 Partial Facade 400001

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.

Warren & Panzer Trio Asbestos Rv1.Crp. C , Print Name of Air Monitor Pri am Asbe nlrattor Pri '3e li nt er hsn Owner)

-- t•, ~av i, f ~—• i

Signature Signature Signal

• --• Date NJ 0Zl

32. I understand that as the owner of a building where asbestos abatement Date Dale ' I ti t

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 filing of this notification for the work specified herein. declare that I have authorized the 55 Liberty Owners Corp. c/o NYC VL ZC,J 1 Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. [A ny modification of information provided on this form must be reported immediately in writing directly to the NYC OEP ACP. The Asbestos Control Program Rules may not be lawfully avoided or ACP7 e performance of work in incremental nr niPr`Gmani 212001

NYC-WTC 000111381