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Asbestos Project Notification form, Oct 2001

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NYC DEP Asbestos Project Notification form for an inspection report submission.

NYC-WTC_000111453–000111499

Folder label: “Zone III Originals

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Scanned page image, NYC-WTC_000111491
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NYC 9/11 Public Portal Document P.a4 TUN-19-2002 13:26 ECTION REPORT (conti ASBESTOS INSP Asbestos Teanstertation — 1k2371 TEL# 631-924-5050 26. Acbestos Hauler a... NYS OGC Permit 4 ; Disposal Site(e) I@Perial/POB 47, 11 Boggs Rd. 1 PA; Southern Alleghenies/rd 3 Box 310, Valleyview, Ba 27. This asbestos abatement is part of a (Item a through e requires filing of this foem with NYC Department of Buildings) a} £7 Gemotition t) C7 oiler Reptacement ¢) £7 Sorincter Reptacement 70 Renovation/Atteration 9Q Fireproofing Repiscement C2 Other (Describe) : 28. TYPE OF ABATEMENT (Check ait appropriate boxes) Cj Removat QO Enclosure QO Encapsulation (J Repair O ciean up 29, ABATEMENT PROCEDURE (Chack all appropriste. boxes) Full Containment CJ. Giovebag ag Tent | OSP Variance Application OF, INO 2 30. LOCATIONS OF ABATEMENT : OESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BE: Floor(s) OF FLOOR CONTAINING AGM PERFORMED (0.9. entire, east wing, toom #, (6.9. Pipe mgging, cating, plenum | SQUARE uNtAR {€.9. running cabie, instating fire sprinklers, . lobby. . CIBAKS. detking, ete) | FEET FEET ing and ro boilers, Roof [item No. 3 11,565 Walls] Item No. 8 3,638 PennNet fp tod CH Air Shaft oof Item No. 3 1,50 Walls! Item No. 3 24,105 31. Chereby dociare that the information provided herein ic sue and complete ta the best of my knowledge. | am tamiliar with Federal, State and NYC laws and regulations applicable to asbastas related work, Warren & Panzer Trio Asbestos Removal NYC Print Name of Ar Montor Prt of Contractor, Print Name of CTother tan Owner LELk la i, (a oP “CE P ‘Sigeoture Signature Sis fon ! CHILD | Sate Le Date 32. | understane that as the owner of a building where asbestos abatement activity occurs, | am responsible for the Pertormance of the asbestos abatement activities in accordanca with the Asbestos i; Program Rules. i have contracted the third party air as Monitor who is completely independent of alt parties involved yfPhe jetes project. | hereby declare that ! have aysharized the A (Ad, DEP e oof» ture % filing of this notification for the wark specified herein, 120 Liberty str. LLC c/o Nyc Print Name of ) NYC-WTC_000111491

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NYC-WTC_000111491Source: NYC Law Department, mirrored locally

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