202 BROADWAY 1001221, 79/19

NYC 9/11 Public Portal Document

Iz AS*T CTtON PORT (cont≥nu 'l

2 .A f t ss Naul~r : (. N4' NYS DEC Permit # f1) — 462 Tt #C1 t . 522223

Disposal Site(s) u P-&D4,e _LA~.1~Ft:t.t. Po 6o+c 399 Scorsvi.,t.E , PA IT254

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) O Sprinkler Replacement d) O Renovation/Alteration e) ❑ Fireproofing Replacement f) ❑ Other (Describe} _

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

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

-PCC{= µATEV-IA-t_- ' cOF ►nEMBi~A^ 1~- 30. LOCATIONS 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, (e g entire, east wing. room (e g Pipe lagging. ceiling, plenum FEET FEET remcv . jep! fl9 boilers, etc.) boiler room, lcbb ,etc dues. stora e tanks, deckm etc.

itCoF RCP S FAcE j 93 130

a MEi a_ S .zFAc-c 3co0

FACADE I WEST Frc-OoE FAcpc , S e.c-cs 2200

koco e te I am familiar with Federal, 31. I hereby edare that the Informal o provided herein is Vue ad complete to the best of my State and NYC laws and regula ons app cable to asbestos r~'.d t- 1 eor`K.

~t1E R tN P1> N R t(vt_yln err 8 z t3Ar~ k 5c~ _ ,u~ _ _. _-. -- 0- rat Name of Air Mcr . asb< c, s a. . Pact Na e n€ Apencarl t't ctner ;non Jwner)

s g, atare i ~ na~..r~ 5.gra e

07-26 _c Z , no,, Gaye Oa;e

of 3; I understand that as the owner of a ag .vhere asbestos abatement actly y occurs. I am responsible for the performance activitie n jcc rdarc:e w,tn 'ho Asbestos Control Program Rules I have contracted the third party air the asbestos abatement project. I hereby declare that I have authorized the monitor who is completely independent of Oil parties mvtYIved in the asbestos filing of this notification for the work specified herein ; ~~ Zr~ ' V P ._ car 26-02 Sig lure -------- oae Print Name of Owner

MUST BE AVAILABLE AT THE WORK SITE. A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS immediately n writing directly to the NYC DEP ACP. Any modification of information rovided on this form must be reported be lawfully avoided or lessened I The requirements of the Asbestos Control Program Rules may not fashion. ( of work in incremental or iecemeal through the performance znoo,

NYC-WTC 000123235