111 READE STREET Block: 145 Lot: 16 BIN: 1001586 AKA's:

NYC 9/11 Public Portal Document A,tit, I U* INbrtt. I ION KtrUK f (continued)

26. Asbestos Hauler L 0 © NYS DEC Permit # c1'~ Tel. — Z7Z 3S 7 Disposal Site(s) OU 22►U ~e 5 \I*(l( fi- l 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) 0 Renovation/Alteration e) ❑ Fireproofing Replacement t) ❑ 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 0 Glovebag ❑ Tent ❑ DEP Variance Application ` G 3n_ LOCATIONS OF ARATFMFNT / DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe tagging, ceiling, plenum SQUARE LINEAR (e.g. running cable. installing fire sprinklers, boiler room, lobby. tc ducts, storage tanks, decking, etc.) FEET FEET removing and replacing boilers. etc.)

i ash

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.

Pint N it itor Prin Name f As stns Contractor Pnnt Nam l of AppIc— ,ant (If other than Owner)

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 th notification for the work specified herein.

Print Name Owner Signature Date

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

I AWInodi7cation of information provided on this form must be reported immediately in writino directly to the NYC DEP ACP. I

444." The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened '.1 through the performance of work in incremental or piecemeal fashion. ACP7 2=1

NYC-WTC 000114731