Permit application for roof work, 182 Broadway, August 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) yr 26. Asbestos Hauler IESi NV NYS DEC Permit# ui-462 TeL# (1ta) 522. 22G3 DisposalSite(s)_6LLE R4D4E LA,3DFIUL PO BOX 399 Sc+trrsDAuz PA 1T254r"~':

27. This asbestos abatement is part of a (Item a through a requires filing of this form with NYC Department of Buildings) a) ❑ Demolition b) ❑ Boiler Replacement c) 0 Sprinkler Replacement d) 0 Renovation/Alteration e) 0 Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Cleanup

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Giovebag ❑ Tent 0 DEP Variance Application

3(t_ LOCATIONS OF ABATEMENT ROOF MATE 4AL : Q.00F MEM BI2Ai3te (TAR) DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. entire, east wing, room #, (e.g. Pipe lagging, calling, Plenum SQUARE LINEAR (e.g. running cable, installing fire sprinklers, boiler room, lobby. etc) ducts, stage tanks, decking, etc.) FEET " FEET removing and replacing boilers. etc)

Root= R.aOF svt2FAC-E 7188 A4.L AoOE' Sort. tOES BULK 1092

PA_APt-t' 123r A1C. 4 wu s t 00 kU.. Ft" C-sc:^PE 4 CA6,E 450 ACAaE NTE>,g4co . FO&AD*S 6590 ++ D3EST Fae.c Pe GAe s:W-F^ 6 2730 I; Noatx DoE fP6.D€. £4,)2. .E cdO

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.

WABRAW i PANZeM C .I0eWV-S 8. W¢ZOAN 4 SON Ca OT"L Print Name of Air Monitor „ Prin Name of Asbestos Contractor Print Name of Applicant (if other than Owner)

t1 Signature Signature Signature

Date Date Date

32. 1 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. _ s Awe oEP o7-r~-o2 Print Name of 07ner Signature Date

A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE WORK SITE.

I_Any modification of information provided on this form must bereported immediately in writin directs to the NYC DEP ACP. The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened .' throughtheperformance of work in incremental or iecemeal fashion. ACP7 212001

NYC-WTC 000122948