NYC 9/11 Public Portal Document
ASBESTOS INSPECTIONb REPORT (continued)
26. Asbestos Hauler _ Transoortation NYS DEC Permit # 1A371 Co.T # 631-924-5050
DisposalSite(s) Im erial/POB 47, 11 Boos Rd., PA: Southern Alleghenies,
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) ❑ Renovatlon/Alteration
e) ❑ Fireproofing Replacement t) 0 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 /~
L
30. LOCATIONS OF ABATEMENT
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•9• Pipe lagging. ceiling. plenum SQUARE UNEAR (e.g. sunning cable, itistaltatg fire sprinklers,
bolter room, ducts, storage tanks. deddnq. eta) FEET FEET and reglalng boilers. eta
Roofs Item No. 3 .Upper Roof 4550
Rootia Lower
Roofs Item No. 3 3,301) ,
44
Roofs Item No. 3 CourElard Area 90
Roofs Item No. 3 nd lr. 125(
Roof
Cou
dt Item No. 8
yaarr h~ws/Walls 441(
south Facade -
Facad Item No. 8 ne Stree 562
acadeItem No. 8 C ar Street 562
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.
Warre & Panzer Trio Asbestos Rvl. Crp NYC
a
P nt Name of Air Pri Asbe Contrpctor rP int Name 7gpp nt (Hotherthen owner)
Signature Signature
V
Date
' p
u /
IL
32. t understand that as the owner of a building where asbestos abatement activijy occurs. I am responsible for
the performance of
Date
the asbestos abatement activities in accordance with the Asbestos Co Rules. I have contracted the third party air
monitor who is completely Independent of all parties involved t e a olnPrOl I hereby declare that I have aqthor edZthe
filing of this notification for the work specified herein.
Downtown Association c/o NYC
Print Name of Owner Signature
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 immediate!y in writing directly to the NYC DEP ACP.
the Asbestos Control Program Rules may
ACP7
h the performance of work in incremental i 212001
NYC-WTC 000114874
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