49 WARREN STREET; 1079151, 133/22

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler L0 C3 /f&I0 _O Q cz "Z7Z"~6'c, NYS DEC Permit Tel. O

Disposal Site(s) 7DU (( 0 e2 2~1;e s . \J+? ( W 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) O Demolition b) O Boiler Replacement C) O Sprinkler Replacement d) O Renovation/Aheration e) O Fireproofing Replacement fj O 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 ARATFutFnrT .iii./ ,,C 1,JC)7i DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR' CONTAINING ACM PERFORMED (e.g enure, last wing. room 0, (e.g. P pe taggng, ceiling, Plc— SQUARE LINE (e.g running cable, installing fre sprinklers, boiler room. bby, etc ducts. storage tanks, . CCC. FEE • FEET ramovi and re lac boilers, etc pp e Vb ( Lt -) l

31. 1 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.

sr_r rs ~u at at,4f tc /SCI (JJC~ Print N ,, itor Pnn Name star Contractor Pnnt Nan of App cal (if other than Owner)

_ Sgnature nature Sgnature

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 air monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authorized the ereip. ~T6 j( Oat MFZZ 4 u =:: ~ Sigrature

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

[ilAn modification of information rovided on this form must be re rted immediate) in writin direct) to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened _throughtheperformanceof work in incremental or iecemeal fashion. ~r Ylo01

NYC-WTC 000113292