Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) Asbestos 26. Asbestos Hauler Transportation CO. NYS DEC Permit # 1A-371 TEL.# 631 —924-5050 • DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies 27. This asbestos Valleyview Dr., PA 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) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement I) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment ❑ Glovebag ❑ Tent 0 DEP Variance Application 30. LOCATIONS OF AFtATFMFMT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM «r)HtiO . DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire. east wing, room k, PERFORMED (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.) 30th [tern No. 3 Setback Roof 2500 9th [tern No. 3 Setback Roof 2000 6th tern No. 3 Setback Roof 2000 2nd :tern No. 3 Setback Roof 2500 9th tem No. 3 Setback Roof 650 th tem No. 3 Roof/HVAC Equip. 7450 th Item No. 8 Facade/Walls 500 ourt- and Item No. 3 Roof 675 our - ard Item No. 8 Facade 9450

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. NYC Pa Name of Air Monitor en Nam of s Contractor Pant Name of Applicant (If other than Owner)

gnature Signature Signature

T7-/7-p2 Oate ate ( Oate

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 Asbe s Contr Program Rules. I have contracted the third party air monitor who is completely independent of all parties involved nth sb St s roject. I ereby declare that I hav auth rized the filing of this notification for the work specified herein. Trinity Morris Corp. C/o NYC d~ Print Name of Owner Signature Oate

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THEW RK 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 ACP7 through the performance of work in incremental or piecemeal fashion. 2rz001

NYC-WTC 000111464