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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_000111493
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NYC 9/11 Public Portal Document a P.a4 JUN-19-2082 13:26 TOS (NSPECTION REPORT (continued) ASBESTOS INS Asbestos Transportation » A371 26. Asbestos Hater @. = NYS O&C Pecmit 4 Disposal site(s) Imperial /POB 47, 14 Boggs Rd., PA; Southern Alleghenies/Rq@ 3 Box 310, Valleyview, Ba 27. This asbestos abatement és part ofa (tema through e requires filing of this form with NYC Depariment of Buadings) 2} C) Oemolition ») C1 Goiter Reptacement Py as | Sprinkier Replacement a0) Renovation/Atteration 2) CJ Fireproofing Replacement 9 2 Other (Describe) : 28. TYPE OF ABATEMENT (Cheek ett appropriate boxes) Oj Removat Q Enclosure 0 Encapsulation [[] Repair oO Clean up 29, ABATEMENT PROCEDURE (Chack alt appropriate boxes) Full Containment = [). Glovenog (J Tent G OSP Variance Application 30, LOCATIONS OF ABATEMENT _. filo: FIFA 1NO 2 OESCRIB SECTION AFFECTED SURFACES AMOUNT OF AGM DESCRIPTION OF WORK BEING SQUARE = uNTAR re. y ©31-924-5050 a Proor(s) (eg. artiw, eoR room &, oo Pen! NC ACM (eg. aningeaae See sptiniers, bodes room, tabby. ¢ . C.IAAks, decking, ete) | FEET FEET ing and boiler. Roof |item No, 3 11,564 Walls] Item No. 8 3,635 Eerie ss L-46g Air Shaft oof Item No. 3 1,50 Walls Item No, 8 24,1705 31. Thereby doctare that the informatian provided herein is true and Complete ta the best of my knowledge. | am familiar with F cderal, State ang NYC faws and ragutations applicable to asbestos related work, Warren & Panzer | tric Asbestos Removal i <s je Pr (ta Connery Print Name of <7 other than Owned V9 22, ! G/it]a_ __Qate_ ~Pzie Date 32. | understang that as the owner of a building where asbestos abatement activity occurs, | am responsible for the performance of ject. | hereby dectare thal t have aythorized the the asbestos abatemant activities in accordance with the Asbestos Con Program Rutes. | have contracted the third party air filing of this nctification for the work specified herein od EP 120 Liberty str. LLC c/o Nyc G ‘ip IE s/o 2 Prirt Name of Owner Sonate . "One 7 f immediately in writi Girectly to the NVC DEP AC® Control Program Rules may hot be lawfully avoided o: lessened ACPY through the erfarmanee of work in incremental or piecemeal fashion. | z20at NYC-WTC_000111493

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NYC-WTC_000111493Source: NYC Law Department, mirrored locally

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