11 RECTOR ST 1000800, 19/21

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) asbestos 26. Asbestos Hauler Iransportation Co. NYSDECPermit# 1A-371 TEL.#631-924-5050 • Disposalsite(s)Imperial/POB 47, 11 Boggs Rd., , PA: Southern Alleghenies/Rd 3 Valleyview Dr., PA 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) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ 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 ABATEMENT ( IA.() a DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK B NG Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers, boiler room. lobby, etc) ducts, storage tanks, decking. etc.) FEET FEET removing and repladng boilers. etc.)

oof tem No. 1 Roof & uncovered 2000 surfaces all Item No. 7 Partial Wall 850 acadeItem No. 7 Partial Facade 750 including awning and ledges

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 Trio Asbestos Rvl.Cor NYC Print Name of Air Monitor Pri am s Contractor Print Name of Applicant (If !tl~Tha ner) 1

Signature Signature Signature w

Date Date Date

32. I understand that as the owner of a building where asbestos abateme activity occurs, I am responsible for the performance of the asbestos abatement activities in accordance with the Asbestos trot rogra Rules. I have contracted the third party air monitor who is completely independent of all parties involved th t pr jec I hereby declare that I have authorized the filing of this notification for the work specified herein. Andrew J. Spyreas c/o NYC Print Name of Owner ' Signature ('4' 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 000113850