Asbestos project notification form, 53 Park Place, undated

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26. Asbestos Hauler Tri State Transfer/ATC NYS DEC Permit # 1A-37511A-371 TEL.# Disposal Site(s)Greenridge Landfill, I Landfill Rd, Scottsdale, PA / Meadowfill Landfill, Rte 2, Box 68, Bridgeport 27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) 0 Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) El Other (Describe) Environmental Clean Up

28. TYPE OF ABATEMENT (Check all appropriate boxes) 0 Removal 0 Enclosure 0 Encapsulation ❑ Repair El Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag 0 Tent 0 DEP Variance . Application_. /rJ 30. LOCATIONS OF ABATEMENT - Z (i U I DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room #, (e.g. Pipe Imaging, ceiling, plenum SQUARE UNEAR PERFORMED boiler roan, lob ;etc) (e.g. running cable, installing fire sprinklers, ducts, tanks, decking, etc.) FEET removing and repladng boilers etc.) PH Entire Debris Clean Up 9,200 Environmental Clean Up 11 Entire Debris Clean Up 9,200 Environmental Clean Up 10 Entire Debris Clean Up 9,200 Environmental Clean Up 9 Entire Debris Clean Up 9,200 Environmental Clean Up 8 Entire Debris Clean Up 9,200 Environmental Clean Up 7 Entire Debris Clean Up 12,000 Environmental Clean Up 6 Entire Debris Clean Up 12,000 Environmental Clean Up 5 Entire Debris Clean Up 12,000 Environmental Clean Up 4 Entire Debris Clean Up 12,000 Environmental Clean Up 3 Entire Debris Clean Up 12,000 Environmental Clean Up

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.

EM & CA Pinnacle Environmental Corp Pinnacle Environmental Corp Print Name of Air Monitor Print ame of Asbestos contractor Print Name of Applicant (If other than Owner)

ignature -- '~ --r Signature ~~ yZkRiU I Signature

Date Da e Date 32. I 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 s tos Jett. 1 hereby declare that I have authorized the filing of this notification for the work specified herein. Lionshead 110 Development LLC.c%o Worldwide Print Name of Owner Holdings ignature Inc Date 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 immediately in writing directly to the NYC DEP ACP requirements of the Asbestos Control Program Rules may not lawfully avoided or through the performance of work in incremental nr ni ACP7 2/2001

NYC-WTC 000115823