Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPEcTION REPORT (continued) Asoestos Transportation 26. Asbestos Hauler Lo _ NYS DEC Permit # 1A-371 TEL.#631-924-5050 DisposalSite(s) Imperial/POB 47, 11 :Boggs Rd., PA; Southern Alleghenies/ 3 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC'~epartr entof 9uldinbs)PA a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement I) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal 0 Enclosure ❑ Encapsulation ❑ Repair ❑ Cleanup 29. ABATEMENT PROCEDURE (Check all appropriate. boxes) ❑ Full Containment ❑ Glovebag 0 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 lagging, ceiling, plenum PERFORMED SQUARE LINEAR (e.g. moving cable, installing boiler room, lobby, etc ci file s nk)ers, duels, storage tanks, decking, etc. FEET FEET removi and replac boilers,, etc.) Roof Item No. 2 terimeter and 4,95 localized areas

Roof Item No. 4 Gravel Roof 90

Facad Item No. 7 North Facade 4,751

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 Eng. Trio Asbestos Removal NYC Print Name of Air Monitor at Nam of tO Ca Print Name at (If other than Owner) eaat«Corp

Sig ure Signature Signature q n Date Date Date

32. 1 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 pir monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have a horize the filing of this notification for the work specified herein. AM Property Holding -Co. c/o NYC (4.. 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 writinq directly to the NYC DEP ACP.

Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 performance of work in incremental or piecemeal fashion. 2/2001

NYC-WTC 000111497