215 PEARL STREET 1001118, 68/4

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) ...t• 26. Asbestos Hauler _I ESIZ Nu _ NYS DEC Permit # W - 4 62 Tel.# •_522- 22.3 • `p

Disposal Site(s) BLUE RIDGE LANDFILL PO 6o- 999 SCeTSt)ALE PA r7254 '

27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) 0 Boiler Replacement c) 0 Sprinkler Replacement d) 0 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

3n 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.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 replacing boilers. etc.)

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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.

u 1'AA2eQ. €f34+tt3cuc"'gs -L VL)C 4 Sci Cci1&L t Name of Air Monitor Print Contractor Print Name of Applicant (If other than Owner) Pi Nt3 , r ds

Signa a Signtatu Signature

G _ C9 -OS—a2 Date a9-GS- C2. Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance air the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party the monitor who is completely independent of all parties involved in the as stos project. I hereby declare that I have authorized filing of this notification for the work specified herein. ii __ v9 f 051 OZ Signature Date Print Name of Owner SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK

{_Any modification of information rovided on this form must bereportedimmediately in writin directs to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened ACP7 throw h the rformance of work in incremental orpiecemeal fashion.

NYC-WTC 000115191