202 BROADWAY 1001221, 79/19

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continue

26. Asbestos Hauler -_LIESL NI NYS DEC Permit # NJ - 462 Tel.# (i t 522- 2263

Disposal Site(s) U3E Rt o4e L.A►aDFI LL £0 PO 399 SccTS V A t,E > 1' . IT254

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) ❑ Sprinkler Replacement • d) ❑ Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe) _ —

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

29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment 0 Glovebag ❑ Tent ❑ DEP Variance Application ~,./~^ !~►1/ 1n I f ATIf kI n ARATGMFMT 2cC.C u eTEt2.IA,L- : rOOF MEM 5 .6.t4E / ~v'°~ ~ VV.

DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED SQUARE LINEAR (e.g. running cable, Installing fire sprinklers, (e.g. entire, east wing, room #, (e.g. Pipe lagging, ceiling, plenum ducts, storage tanks, decking, etc.) A removing and replacing boilers, etc.) boiler room, lobby, etc)

ROOF' ROOF SC42F1.caE 93_30 N METAL SuerACES 3000

FACAOE WES1 c, DE FecAVE SccES 2200

31. I 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.

Ct1ARRCf~i f Pi NZ. R ENGI1 ) k cd ' B. iGa A26AM SCy4 Q.y Print Name of Air Monitor int me of Asbestos Contractor Print Name of Applicant (If other than Owner)

Signature Signature Signature

O7 - 2E —02. OT— 2 6-02 -- Date Date Date

of 32. I understand that as the owner of a building where asbestos abatement activity occurs, I am responsible for the performance air third party the asbestos abatement activities in accordance with the Asbestos Control Program Rules. I have contracted the authorized the monitor who is completely independent of all parties involved in the asbestos project. I hereby declare that I have filing of this notification for the work specified herein. OT-2-62 _ Sig lure Date Print Name of Owner WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE AVAILABLE AT THE directly to the NYC DEP ACP. iil Any modification of information provided on this form must be reported immediately in writing The requirements of the Asbestos Control Program Rules may not be lawfully avoided or lessened through the performance of work in incremental or piecemeal fashion. ACP7

NYC-WTC 000123244