35 Ann Street 104-108 Nassau St. BN# 1001273

NYC 9/11 Public Portal Document

35 Ant N G-r € -r

ASBESTOS INSPECTION REPORT (continued)

26. Asbestos Hauler IESI,NY NYS DEC Permit # NJ-462 Tel.# (718) 522-2263 Disposal Site(s) BlueRidge Landfill PO Box 399 Scotsdale, Pa 17254 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/Atteration e) ❑ Fireproofing Replacement I) El Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair Ja Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) / ~ ~ 0 Full Containment ❑ Glovebag 0 Tent 0 DEP Vari ance Application O 'An I (%r_ATIltJC AC ADATcucuT n_ —n- DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM (e.g. entire, east wing, room p, (e.g. Pipe lagging, ceiling, plenum SQUARE LINEAR PERFORMED (e.g. running cable, installing fire sprinklers. ers, boiler room, lobby, etc) ducts, storage tanks, decking. etc. FEET FEET removing and reglacjng boilers, etc.)

I=ACADE (t_cu ecoF) 182.5 I,u ROO PARAFtTr LED6C- TO tl PA(2 PzT (L ALL 584 tt t OO se!- AC+c 13 80 FACA (UFPre Door-) t54t~1. uvvF~ F RcoF 'S0 -FAc i5 84 a 6Utrtc tGA~ 1100 tt Des wc;rzi 304 it A/Ut.. I5 (2) $00 It PA r -'e t L ~ 3 32

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.

n Prin=Ai of nitof Pint Name of Asbestos Contractor

Signature Pnnt Name of Applicant (If other than Owner)

Signature

— -- ate Date ---- - — 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 asbestos project. I hereby declare that I have authorized the filing of this notification for the work specified herein.

102 Print Name of Owner Signature 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. 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. ACP7 V2001 3

NYC-WTC 000116529