Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

bestos ASBESTOS INSPECTION REPORT (continued) As 26. Asbestos Hauler Transnortation NYS DEC Permit #1 A=371 Co TEL# 631-924-5050 Disposal Sites) _ Imperial/POB 47, 11 Boogs 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) 0 Fireproofing Replacement I) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Endosure . ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent ❑ 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 A, (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) Roofs Item No. 3 Upper Roof 4550 Roofs Item No. 3 Eartia Lower 3300 4 Roofs Item No. 3 r ourFlard Area 900 Roofs Item No. 3 nd Fir. our yard Roof 1250 Carr dt Item No. 8 ~lint dows/Walls 441 gg Facad Item No. 8 PonehSFree a 562 acade-Item No. 8 North Facade- Cedar Street 562

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.

Warre & Panzer Trio Asbestos Rvl. Crp NYC Pmt Name of Air itor P. ame Asbe Contactor Print Name o App nt (If other than Owner)

Signature Signature Signature

Date ate Oats

32. I understand that as the owner of a building where asbestos abatement activ y occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos Co of o Rules. I have contracted the third party air monitor who is completely independent of all parties involved involvedM ' tea proje (.1hereby dedare that I have a thori ed the filing of this notification for the work specified herein. Downtown Association c/o NYC 4 Print Name of Owner Signature ate 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 OEP 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. 2/2001

NYC-WTC 000111476