License agreement for debris removal, 105 Reade Street, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler Lc j0 NYS DEC Permit —O Tel. 2.7?

Disposal Sites) _OU €kj) I~ eN to 5 F// 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) O Sprinkler Replacement d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement 1) ❑ 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 O Glovebag O Tent O DEP Variance Application

30. LOCATIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM I PERFORMED (e.g. entire, east wing, room li, (e.g. Pipe lagging, ceiling. plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers. boiler room, lobby, etc) ducts, storage tanks, deding. etc.) FEET ! FEET removing and replacing boilers, etc.)

Ewe, 3510 39

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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. I.

SCI ! r Pint N it c M / cdf r,,- x/ c1 itor Prin Name I Asbestos Contractor Print Nam of App .ant (It other than Owner)

r Signature gnature Signature

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 this notification for the work specified herein.

Print Name of Owner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. A I An of information provided on this form must be reported immediately in writing directly to the NYC DEP ACP. I requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. Accr area, I

NYC-WTC 000114599