Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) Asbestos Transportation 1 26. Asbestos Hauler r r

NYS DEC Permit # 1A-371 TEL.#( 631 ) 9245050

DisposalSite(s) Imperial/P.O. Box 47, 11 Boggs Rd.PA; Southern Alleghenies/Rd 3 Box 310 Valleyview 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 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal ❑ Enclosure ❑ Encapsulation ❑ Repair 0 Clean up 29. ABATEMENT PROCEDURE (Check all appropriate.boxes) ❑ Full Containment ❑ 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 #, (e.g. Pipe lagging. ceiling. plenum SQUARE LINEAR (e.g. running cable, installing rue sprinkler:, boiler room, lobby, etc) ducts, storage re tank's. decking, etc E removing and replacing boilers, etc.) 28 Trinity

oof Item No. 1 1.450 oof Item No. 4 800 ells Item No. 7 2,475

67 Greenwich Roof Item No. 2 3,200 Walls Item No. 7 390 Facad Item No. 7 2,500

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 Removal NYC Prime of , Monitor P, an r Asbest onUad or p . Print Name of Applicant (If other than Owner)

Signature Signature Signature

Date 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. 67 Greenwich LLC c/o NYC 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 Asbestos Control Program Rules may not be lawfully avoided or ACP? 2!2001

NYC-WTC 000111486