NYC 9/11 Public Portal Document
DEP ECB Fax:212-361-1433 Jun 28 2002 11:23 P.02
ASBESTOS INSPECTION REPORT (continued) ,
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26. Asbestos Hauler NYS DEC Permit O12. Tel. o ^CICJ'"?.
Oisposel Sits(s) ~Q~ ekp 1 e es
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27. ThIs asbestos abatement is part of a (item a through a requires filing of this forth with NYC Department of Buildings)
a) ❑ Demolition b) 0 Boiler ftepiacement c) ❑ Sprinkler Replacement - d) ❑ Renovation/Alteration
a) ❑ Fireproofing Replacement t) ❑ Other (Describe) — --- --- -
28. TYPE OF ABATEMENT (Check all appropriate boxes)
❑ Rsmovel '❑ Enclosure 0 Encapsulation ❑ Repair ❑ Cleanup
29. ABATEMENT PROCEDURE (Check all appropriate boxes)
❑ Full Containment ❑ Olovebag ❑ Tent ❑ DEP Variance Application
AIJ. VV4rA 1I r.V Vr
DESCRIBE SECTION AFFECTED SURFACES AMOUNT OF ACM I DESC ION OF WORK BEING
Floor(s) OF FLOOR CONTAINING ACM PERFORMED
SQUARE LINEAR (e.g. runni+g able. 6uulrap fire eprinklsrs.
ttaq. Md►t, asst wuy. room )11. (e.p. Pipe is gin;, uiGnp, plenum
FEET
a tanks, ds FRET rem end rep n
goiter room, lobby. etc) du
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Federal,
31. I hereby declare that the information provided hereir is true and complete to the best or my knowledge. I am familiar with
State and NYC laws and regulations applicable to asbestos related work.
for the performance of
32. I understand that as the owner of a building where asbestos abatement activity occurs. I am responsible
have contracted the third party air
the asbestos abatement activities In accordance with the Asbestos Control Program Rules, I
project. I hereby declare that I have authorized the
monitor who is completely independent of all parties Involved in the asbestos
~ftling tiff lion for the work specified her
;a —
—.. i
rrins NenN t owner
AVAILABLE AT THE WORK SITE.
A STAMPED COPY OF THIS FORM INCLUDING AMENDMENTS MUST BE
atel in writin dir to th NY P P.
An modification of information r vided on thi form m st be r d Irn
ACPM
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NYC-WTC 000126292
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