1 PARK ROW 1085949, 90/1

NYC 9/11 Public Portal Document

t s ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hader-<.ø g tJ O NYS DEC Permit Disposal Site(s) 27. This asbestos abatement Is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 13 Demolition b) O Boiler Replacement c) 13 Sprinkler Replacement • d) 13 RenovatiorwAReratIon e) O Fireproofing Replacement f) O Other (Describe) 28. TYPE OF ABATEMENT (Check all appropriate boxes) O Removal O Endosure O Encapsulation ❑ Repair ❑ aeon up

29. ABATEMENT PROCEDURE (Check all appropriate boxes) O Full Containment O Glovebag O Tent O DEP Variance Application 9n a ANAr1f%UQ I AQATGIIG\R p~S~y~1d3 ------------ -- -- -------------- DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) - OF FLOOR CONTAINING ACM PERFORMED (e.g. enO's. east wing. room $. (e.g. Pipe lagging. ceanD• plenum SQUARE .. eale. k (s.Q. na IM and ing sp s. eater room. . etc ducts. . etc. KET W reptadng ballets, eta.) / I v YV

3't t 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. V. _ _ ter= MtJME j,Z 1Name/I c,Y Contractor . /4;yf/ I/ S(,4- Pray Na. of App nt (If other thin o.a»t

• b_- o3-oa rite Pete 3- ca Oats

32. 1 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 i' of this notifcati the specified herein Y l.—. Print Name er

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

-- 1 Any modification of information provided on this form must be reported Immediately In writ!r direct!y to the NYC DEP ACP. of the Asbestos Control Program Rules may not be lawfully avoiaea or

NYC-WTC 000115795