Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) Asbstos 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 abatement is part of a (Item Valleyview Dr., PA 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 f) ❑ Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM //di i I H3J7j2. DESCRIPTION O WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire. east wing, room it, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc ducts, storaoe tanks, decking, etc.) FEET FEET removing and replacing boilers. etc.) Roofs Item No. 3 Main/Upper Roofs 5500 Roofs Item No. 6 Main/Upper Roofs 7800 Roofs Item No. 8 Main/Upper Roofs 400 22nd Item No. 3 Setback Roof 6140 22nd Item No. 8 -Walls Windows 2550 18th Item No. 3 Setback Roof 4760 18th Item No. 8 e ac - a s Windows 3500 16th Item No. 3 Setback Roof 2740 16th Item No. 8 Set ac -Wal s [Windows 25601 12th Item No. 3 Setback Roof 2800 L T .- ILLS! 1Leit wo. LS Setback-Walls/ 1980 Windows 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 Print Name of Air Monitor Prin ame b ontractor Print Name of plicont (If other than Owner) _ _.

Signature Signature Signature

7-n-02- Date si í: 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 Conn I Pro ram ales. I have contracted the third party air monitor who is completely independent of all parties involved in t sb $ o p of . I hereby declare that I have authorized the filing of this notification for the work specified herein. 45 Wall Str.,LLC c/o Rockrose f 3~ Print Name of Owner eve , do NYC Signature 0 to A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE AORK SITE.

An modification of information rovided on this form must be re orted immediate) in writin direct) to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 I throughtheperformanceof work in incremental or iecemeal fashion. 212001

NYC-WTC 000111466