50 BROAD STREET 1000820, 24/36

NYC 9/11 Public Portal Document

ASBFST3SSINSPECTION REPORT (continued) , Asbestos 26. Asbestos Hauler Transportation Co. NYSDECPermit#1A-371 TEL.#631-424_5050 DisposalSite(s) Imperial/POB 47, 11 Boggs Rd., PA: Southern Alleghenies Valleyview Dr., PA 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/Afteration e) ❑ Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure 0 Encapsulation 0 Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) 0 Full Containment ❑ Glovebag 0 Tent ❑ DEP Variance Application

30 LfCATIC)NS OF: ARATFMr MT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK Floor(s) OF FLOOR ING CONTAINING ACM PERFORMED (e.g. entire, east wing, room k, (e.g. Pipe tagging, ceiling, plenum SQUARE LINEAR (e.g. running cable, installing rice sprinklers, boiler room, lobby, etc) ducts, Storage tanks, decking. etc.) FEET FEET removing and replacing balers. etc.) oofs Item No. 3 Partial Roofs 13500 acad s Item No. 8 Partial Facades 42120

31. 1 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.

Warren & Panzer Trio Asbestos Rvl.Crp NYC w _ _ Print Name of Monda Pn r aae"Dr As CgWactor Print Name of Applicant (H other than Owner)

Signature Signature Signature (j Oat 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 Rullfs. 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 fling of this notification for the work sgecified herein. 50 Broad Street, Inc./50 New Street, Inc:, print Name d owner ~~~~ C/ Signature Date O NYC 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 law .illy avoided or lessened ACP7 through the performance of work in incremental or piecemeal fashion. 212001

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NYC-WTC 000118509