Asbestos abatement project notification form for 217 Broadway, 2002

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) 26 Asbestos Hauler EWN&S TRANSPORT INC. NYS DEC Permit # Tel.# X18) 273-0428

Disposal Site(s) ATHENS HOCKING RECLAMATION 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) ❑ Renovat on/Alteratlon e) ❑ Fireproofing Replacement t) ❑ Other (Desk dbe) EMERGENCY CLEAN-UP ER128-01

28. TYPE OF ABATEMENT (Check all appropriate boxes) ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ® Clean up /1ijO 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Ful Containment ❑ Giovebag ❑ Tent ❑ DEP Variance Application

30. LOCATIONS OF ABATEMENT dI) $ DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM DESCRIPTION OF WORK EING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g. erare, eastwhrg, room 0, (e.g. Pipe lagging. ceweg. plenum SQUARE t NEAR (e.9. running cable, hrstalfng fire sprinklers. boller room. lata eta thi . storms tanks. deddno. etc) T FEET and replacing boWers ate.) 10 FIR ROOF ROOF 20,000 EMERGENCY CLEAN-UP

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.

A.E.C.C. AA SERVICES LLC J. RENSiNK Prhrt Naam of AU Monaor Pri Asbestos Contractor Print N AppgaerU (H oUrer than Owner) nn

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9/24/01 9/24/0 9 Data Data Date

32. I 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 invoked In the project. I hereby declare that I have authorized the filing of this notification for the work specified herein. JOHN DI MURRO .~-- Prkd Name ar Owner t3lgnature

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

I Any lion of Information on this form must be reoorted immediately In wrltlna directly to the NYC DEP ACP. 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. ACPT anoot

NYC-WTC 000123326