ASBESTOS INSPECTION REPORT (continued) -Z72-3& 7
(_ 3M NYS DEC Permit
26. Asbestos HaulK
toôul S (s) ~ Buildings)
this form with NYC Department of
of (Item a through a requires filing of
27. This asbestos abatement is part a a) ❑ Renovation/Aheration
b) ❑ Boller Replacement c) ❑Sprinkler Replacement
a) (a Demotltlon
e) ❑ Fireprooring Replacement A ❑ Other
(Describe)
(Check all appropriate boxes)
26. TYPE OF ABATEMENT 0 Repair [) Clean uA
Remav~l E~ Znc~o~ure ❑ Encep$utaUon
; c.., '
(Check all appropriate boxes) .
29. ABATEMENT PROCEDURE Variance Appffcation O t 'I v
0 Glovebeg 0 Tent ❑ CEP
❑ Full Containment , Q
`
best of my knoWAecge. I am familiar with Federal,
provided herein is true and complete to the
31 I hereby declare that the Information applicable to asbestos related work.
State and NYC laws and regulations
I am the rformance of
ot dawcere .sbeetos nt contracted thethird party air
32, 1 understand that iP ogam Rules I h ave
a
stheowtivtieseIn aloe wtth the AsbestosControl hereby declare that I have authorized the
the asbestos abatement parties involved in the asbestos project. 1
independent of all
monitor who is
filing of
completely
cation for the workspecified heroin = —
, s s . o,k
PrtN Name or O+er
THE WORK SITE.
FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT
A STAMPED COPY OF THIS - .. ..... ..w •M
__-_
?P7
atmol
NYC-WTC 000121968
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NYC-WTC_000121968Source: NYC Law Department, mirrored locally