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 Valleyview Dr., PA 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) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement 0 ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair 0 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 DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room X. (e.g. Pipe lagging, ceiling. plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby, etc) ducts. store a tanks, decking. etc.) FEET FEET removing and replacing boilers, etc.)

oof :tem No. 1 Roof/Ducts/HVAC 2260 acadeItem No. 7 Walls/Facade 1000

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 Rvl.Crp. NYC not Name of Air Monitor Prj Ny of os Contractor Print Name of Applicant (Itotherthan Owner)

y7 A- Signature ______ Signature ______ Signature

______________ Ji JL2 ______________ Date Date Date u 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 Coi'flrclProgram R1iles. I have contracted the third party air monitor who is completely independent of all parties involved n t e 1b soyoiect. I hereby declare that I have authorized the filing of this notification for the work specified herein. Windsor Place Corp. c/o NYC Print Name of Owner sign. re Ole

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

ny modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACPIJ 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. 22001

NYC-WTC 000111468