NYC 9/11 Public Portal Document
ASBESTOS INSPECTION REPORT
PREMISE NO. S REST INSP CTIO DATE
FLOOR ZIP BORO CODE BLOCK LOT SQUAD Ir B GE .
F4^u. t T s'
IN fl p 4 BL P BASIS OF INSPECT M ' Ii 93A NU PHOTOS TAKEN NO
CONTRACTORS NAME I J SAMPLE NO.
C~~V)
ADDRESS j ~~ CITY ` f_ SAMPLE NO
h~
STATE J
'1 ZIP /( PHONE / SAMPLE NO
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LABORATORY lj- ~ ~/ OWNERS NAME
ADDRESS ~ 1 CITY ADDRESS CITY
STATE ZIP PHONE STATE ZIP PHONE
CONTACT PERSON. TIME OF INSPECTION FROM. -&Wop
c, ---- TO ,&ml rr
Inspection disclosed that the following Requirements, Specifications,
rocedures were complied with
Vection 1-51 Notifications, Reports, Plans, and Fees
'37' Section 1-71 Air Sampling, Monitoring, and Analysis
❑ Section 1-91 Worker Protection
❑ Section 1-101 Materials and Equipment
Section 1-116 Work Place Preparation
❑ Section 1-117 Worker Decontamination Enclosure System
❑ Section 1-118 Waste Decontamination Enclosure System
❑ Section 1-126 Engineering Controls 0 Section 1-127 Entry/Exit
❑ Section 1-128 Equipment, Waste Decontamination & Removal
❑ Section 1-129 Maintenance of Decontamination System & Barriers
Section 1-137 ACM Disturbance, Handling, & Removal
❑ Section 1-138 Encapsulation 0 Section 1-139 Enclosure
❑ Section 1-140 Glovebag 0 Section 1-141 Tent
^-C!:minary Clean Up
❑ Section 1-147 Final Clean Up
❑ Project ongoing, expected completion dated F
0 Project completed on or about I --All surfaces, including abated surfaces are
free of visible ACM debris and Encapsulated
❑ No Acces3 Premise 0 Locked, No response to bell or knocks 0 Abandoned
0 Inspection based on complaint, no ACM being disturbed or present
❑ Variance Inspection-Approved/Disapproved. Section (s)
0 Follow Up Necessary
Contact person at the site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Additional Comments
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NOV a INFRACTIONS RESULT CODE
7 —
NOV SUPER IS RS INITIALS
BORO 1 . MANHATTAN 2 - BRONX 3 = BROOKLYN 4 . QUEENS 5 RICHMOND
BLDG TYPE A > 6 Stones B < 6 Stones C Single Family
D School E Hospital F Public Ownecl Property
RESULT CODES 1 a V,oIat,on Issues 2 - No Violations Issued 3 = No Access
4 _ Project not Startea'No NOV 5 = Project Completes INo NOV , ACP 30;;2
NYC-WTC 000118138
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