Asbestos Project Notification form, Oct 2001

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued Asbestos Transportation 26. Asbestos Hauler o- NYS DEC Permit # 1A-371 TEL.# 631-924-5050 DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA; Southern Alleghenies/Rd 3 27. This asbestos Valleyview Dr., PA 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 f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation ❑ Repair El Clean up 29. ABATEMENT PROCEDURE (Check all appropriate. boxes) El Full Containment ❑ Glovebag El Tent ❑ DEP Variance Application / ry 30. LOCATIONS OF ABATEMENT ~ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTI N OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room C. (e.g. Pipe lagging, ceiling, plenum PERFORMED ARE LIINEA (e.g. running cable, installing fire sprinklers. boiler room, lobby, etc ducts, storage tanks, decking. etc.) FEET removing and replaang boilers, etc.) Cooli tg Item No. 6 Gravel Roof 7,000 Tower Item No. 3 Dunnage/Pipe. .: 7,600 (partial)

Upper Item No. 3 Roof (partial) 500 Roof

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 nt N cot tos Contractor Print Name of p ((It other than Owner) Cor

Sig lure Signature Signature

6m1 Date Date Oate

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 p oject. I hereby declare that I have uthori d the riling of this notification for the work specified herein. Federal Reserve Bank c/o NYC 4( al , 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 requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 through the performance of work in incremental or piecemeal fashion. 212001

NYC-WTC 000111499