Permit application for subway entrance closure at 189 Broadway, Nov

NYC 9/11 Public Portal Document

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3. Asbestos Hauler _ NYS DEC Permit # Tel.#

Disposal Site(s) ---- of Buildings) 27, This asbestos abatement is part of a (Item a through e requires filing of this form with NYC Department a) ❑ Demolition b) 0 Boiler Replacement c) ❑ Sprinkler Replacement d) ❑ Renovation/Alteration

e) ❑ Fireproofing Replacement f) 0 Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Enclosure ❑ Encapsulatioh C Repair 0 Clean up ❑ Removal

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

30 LOCA TIONS OF ABATEMENT DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING OF FLOOR CONTAINING ACM PERFORMED Floor(s) SQUARE LINEAR (e.g. running cable, installing fire sprinklers, m ceiling, egging. plenum t a g.entire. east wing room #,- (e. g P.pe la n9, P- FEET FEET removing and rep acing boilers, etc j boiler room, lobes, et ducts, storage tanks, decking_etc

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_IiI i **H *I±ii knowledge. I am familiar with Federal, 31, I hereby declare that the information provided here n is true and complete to the best of my State and NYC laws and regulations applicable to asbestos related work.

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a , Pr,,rl Na-11, of Av klondor Pnnt N e of Asbestos Contractor

/f Signature ,Signat ure Signature f )p tu i f C !1 /' j Date Date Date

I am responsible for the performance of 32. I understand that as the owner of a building where asbestos abatement activity occurs, abatement activities in accordance with the Asbestos Contro Program Rules. I have contracted the third party air the asbestos monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have authiopized the filing of this notificatio for the wor~pecified herein.

Signature Oate Print Name orpwne — — — —

AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE in writing directly to the NYC DEP ACP. Any modification of information provided on this form must be reported immediately lawfully avoided or lessened The requirements of the Asbestos Control Program Rules may not be performance of work in incremental or piecemeal fashion. ncr through the ---- ------ — 2L

NYC-WTC 000123063