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# 1 A-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 t) ❑ Other (Describe)

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

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

30. LOCATIONS OF ABATEMENT /" /' /s ff 'wOL DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION Ol WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE L~ EAR (e.g. entire, east wing, room a, 9, ceiling, lagging, (e.g. Pipe 99~ 9 plenum (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts, storage tanks, decking. etc.) FEET FEET removing and replacing boilers. etc.)

39th Item No. 3 Partial Roof 405 p Roof 19th Item No. 3 Sebac 70 11th Item No. 6 Roof Setback 11800

6th Item No. 6 Roof Setback 2125 6th Item No. 7 Partial Facade 800

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 P t Narr f A) t s Contractor Print Name of Applicant (If other than Owner)

t)I tL.tr.ib ~ U( .S. Signature nature Signature

Oat 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 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 declare that I have authorized the filing of this notification for the work specified herein. 60 Broad Street, LLC c/o NYC [ 4L Print Name of Owner Signature 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 I ACP7 through the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000111470