NYC 9/11 Public Portal Document
ASBESTOS INSPECTION RORT (continued) A
26. Asbestos Hauler ASBESTOSTRANS. CO. NYS DEC Permit # 1A-371______ Tel # (631) 924-5050
Disposal Site(s) IMPERIAL P.O. 47, 11BOGGS RD., PA /_SOUTHERN ALLEGHENIES- VALLEYVIEW DR., PA
27. This asbestos abatement is part of a (Item a through a
requires filing of this form with NYC Department of Buildings)
a) ❑ Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration
e) ❑ Fireproofing Replacement f) ❑ Other (Describe) _________________
28. TYPE OF ABATEMENT (Check all appropriate boxes)
❑ Removal ❑ Enclosure 0 Repair
❑ Encapsulation 0 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 lagging, ceiling, plenum SQUARE LINEAR
PERFORMED
(e.g. running cable, installing fire sprinklers,
boiler room, lobby,etc) ducts, storage tanks, decking, etc.) FEET FEET removing and replacing boilers, etc.)
ROOF- 5th FLOOR SETBACK ROOF, DUNNAGE, DUCTS 1,940 ITEM #2
ROOF PENTHOUSE ROOF, LOUVERS 2,000 ITEM #2
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. P.C. TRIO ASBESTOS REM. CORP. NY
Print Name of Air Monitor Print Name of Asbestos Contractor All
Pr e of I r than Owner)
Signature S ature Sig ature
c) - o r
r;
cr
Date ----
Date Date
32. I understand that as the owner of a building where asbestos abatemen c vity o urs, am
responsible for the performance of
the asbestos abatement activities in accordance with the As stos C tro Pro . I have contracted the third party air
monitor who is completely independent of all parties involy in t be lect. I ereby declare that I have authorized the
filing of this notification for the work specified herein.
FINANCIAL DISTRICT ASSOCIATES LLC
Print Name of Owner Signature
r•: 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
through the performance of work in incremental or piecemeal fashion.
ACP7
212001
NYC-WTC 000113705
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