1 PARK ROW 1085949, 90/1

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler (. o )0 NYS DEC Pemdt C O Tel Z723(%? Disposal Sites) O ek (1 . 5 ~ '(

27. This asbestos abatement is part of a {Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) ❑ Sprinkler Replacement • d) ❑ RenovatwNAtteration 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) ❑ Glovebag 0 Tent ❑ DEP Variance Application 0 Fu8 Containment 4n I ArATInMC flF £RATFMPUT oisd~Ha a3 DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) - OF FLOOR CONTAINING ACM PERFORMED (e.g cadre, east wing, room I. (e.g. Pipe legging, ceiling, plenum FEET E (e.g. nr g cable. instilling tiro spinklets, etc. FEET FEET and teaclng boilers. etc Eoser ducts p ,

3't..' 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.

-~~jsclrrr c~Fc~t+~tC~ Iv[ C17J _ Part itot Name Contractor Pnnt Na. of Appant (if otter that Owner)

S

Gate Date Date

32. 1 understand that as the owner of a building where asbestos abatement activity occurs, tam 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 whonotifica Is completely . independent of all parties Involved In the asbestos project. I hereby declare that I have authorized the I of this the specified he —~ tNc Print Name of

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE the NYC DEP ACP. Any modification of Information provided on this form must be reported Immediately In writinq directly to 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. I 1z" Smoot I

NYC-WTC 000115753