Asbestos inspection report form, 49 Broadway, July 2002

NYC 9/11 Public Portal Document ASBESTOS INSPECTION REPORT (continued) : 26. Asbestos Hauler AtC _NYS DECPert#_1A-371_TEL#(631)924-5050 Disposal ste(e) Meadadfil|Rte#2 B0268 Bridgepoit WV 27. This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department of Buildings) a) L Demolition b) • Boiler Replacement e) • Fireproofing Replacement n • Other (Describe) c) Sprinkler Replacement d) Renovation/Alteration 28. TYPE OF ABATEMENT (Check all appropriate boxes) U Removal • Enclosure • Encapsulation • Repair • Clean up 29. ABATEMENT PROCEDURE (Check all appropriate. boxes) • Full Containment •] Glovebag • Tent • DEP Variance Application 30. LOCATIONS OF ABATEMENT DESCRIBE SECTION Floor(s) OF FLOOR (e.g. enlire, east wing, room #. boiler room, lobby, elc) AFFECTED SURFACES CONTAINING ACM (e.g. Pipe lagging, celling, plenum ducts, storage tanks, decking, elc.)_ Roof Item No. 3 Nalls Item No. 7 FacadeItem No. 7 AMOUNT OF ACM SQUARE FEET LINEAR FEET 9850 5160 500 TAU0807ANOZ DESCRIPTION OF WORK BEING PERFORMED (e.g. running cable, installing fire sprinklers, removing and replacing bollers, elc.) 1. I hereby declare that the informationprovided herein is true and complete to the best of my knowiedge. Iam familiar with Federal. State and NYC laws and regulations applicable to asbestos related work. WarIen Panzer Print Nam of Air Monitor 1x10 Asbesto coIp: Nargeg! Asbesos Contract Removal NYC Print Name of Applicant (If other than Owner) signature 6-4-42 Signature Signature Date Date Date I understand that as the owner of a building where asbestos abatement activity occurs, 1 am responsibie for the performance of the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the third party air filing of this notification for the work specified herein. h1 Midtown Property c/o NYC Print Name of Owner Signature A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE. Any modification of information provided on this form mustbe 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. ACPT 2/2001 NYC-WTC_000118065