License agreement, 211 Pearl Street, Aug 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler _I ESI, N4 NYS DEC Permit #_i4 - 4 62. Tel.# C't t l3) 522- 2263

Disposal Site(s) BLUE w DG E t.A NO Ft LL PO tax 399 ScmrsDAt - PA 1 r 2 54

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 0 Repair ® Clean up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ DEP Variance Application

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

ROOF 2-OOF Sc-ACE 2522 ROOF -r28 MeT L-. 4 A/C uN trS 1000 FeCADE EAST FACADE feIAOE Su¢.FAC'.E 2£330

it U T Cse'D Fec. z✓A - 2340 Re -e 300 1=Lu C Pt P t=_ saa

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.

I~ QPw—.1 $ ?RN-Z 61ti 5S -B , VO . BA SON ► y..cL. _ t Name of Air Monitor P ame of bestos Contractor Print Name of Applicant (If other than Owner)

SignatiI Sig ature Signature

t -t: -o 2- O9.-05-02 Date Date Date

32. 1 understand that as the owner of a building where asbestos abatement activity occurs, t 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. .- c_ C L̀O51O.2 Print Name of Owner Signature Date

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

J writingdirectly to the NYC DEP ACP. Acy modification of information rovided on thisformmustbereportedimmediately in writing The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. ACPT aacci

NYC-WTC 000115319