Asbestos project notification form for 18 Vesey Street

NYC 9/11 Public Portal Document

_- ASBESTOS INSPECTION REPORT (continued) `v

26. Asbestos Hauler __0 1U0 NYS DEC Permit Tel. Disposal Site(s) O O( e2 e 5 I 6

27. This asbestos 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) 0 Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe) _ -

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair 0 Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑DEP Variance Application

sn LOCATIONS OF ARATFMFNT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK EING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e g entire, east wing. room tl, (e.g. Pipe lagging, ceiling. plenum SQUARE LINEAR (e.g running cable, installing fire sprinklers, boiler room, etc ducts. store a tanks, decking. etc. FEET FEET removing and replacing boilers, etc.) b_by. l ob —c r~ C` rC 1.~1 S S

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.

St1rr Pnnt N tr tCrttitMtE itor Prin Name/f Asbestos Contractor LrZ c)(,c1/ ~ 11 Gs Pnnt Nam of Appfr` nt (If other than Owner)

Signature gnature Signature

off- 03 0~ oz ___ Date 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 party air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the filing of th' notifica ' n for the work specified herein.

Pnnt 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 through the performance of work in incremental or piecemeal fashion. ACP7 ?/2001

NYC-WTC 000111906