Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) sbestos Transportation 26. Asbestos HaulerCo.. NYS DEC Permit # 1A-371 TEL.# 631-924-5050 DisposalSite(s)Imperial/POB 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) 0 Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) El Renovation/Alteration e) 0 Fireproofing Replacement I) ❑ Other (Describe) _ _ 28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ 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 (e.g. entire, east wing, room #, (e.g. Pipe tagging. ceiling, plenum SQUARE LINEAR PERFORMED te. r running cable. lcin installingb fire , sprinklers, boiler room, lobby, etc ducts, slora a tanks, decking, etc. FEET FEET removing and replacing boilers, etc.) 4th Item No. 2 Roof only, no 3,500 equipment except intake louvers 15th Item No. 2 Roof (partial) 1,500

31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. lam familiar with Federal,. State and NYC laws and regulations applicable to asbestos related work.

Warren & Panzer Trio Asbestos Removal NYC Print Name of Air Monitor Print e t s onlraclo~0 r Print Name licant (If other than Owner) p /

Si lure Signature Signature

Date (_ (/2//&_ 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 pajty air monitor who is completely independent of all parties involved in the asbe oject. I hereby declare that I hay authored the filing of this notification for the work specified herein. Brown Brothers Harriman c/o NYC 1, d Print Name of Owner Signature Date A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

LA ny modification of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 ugh the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000111495