Asbestos project notification form, 100 Church Street area, undated

NYC 9/11 Public Portal Document

ASBESTOS INSPECTION REPORT (continued) o __ ¢~ 26. Asbestos Hauler C4 hiYS DEC'Permit —o Tel, O ..~7Z — < 7

Disposal Site(s) U( e& N fE ~e 5 IQ'( i '~ 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/Aheration e) ❑ Fireproofing Replacement f) ❑ Other (Describe)

28. TYPE OF ABATEMENT (Check all appropriate boxes) '• ❑ Removal ❑ Enclosure ❑ Encapsulation ❑ Repair ❑ Clean up 29. ABATEMENT PROCEDURE (Check all appropriate boxes) ❑ Full Containment ❑ Glovebag ❑ Tent ❑ OEP Variance Application 30. LOCATIONS OF ABATEMENT ~~iIIIJ wz DESCRIBE SECTION I AFFECTED SURFACES AMOUNT OF ACM D —E CRIPTI N OF WORK BEING Floor(s) OF FLOOR CONTAINING ACM PERFORMED (e.g s lire. east wing. room N, (e.g. Poe b9gig. oearg. plenum SQUARE LINEAR (e.9 runnog able. installing Ire sprinklers, baler room lQby. etc) s. storage bnks. . ete.) FEET • FEET removing and reiadng boiters. etC.)

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31. I hereby declare that the information provided herein is true and complete to the best of my knowledge. lam familiar with Federal. State and NYC laws and regulations applicable to asbestos related work.

_ S~c'_'r Pnm N . u ctatr .t ~tt~Ao for - [;~~y Prin Name Contractor Pnnt Na." otApp nt (it Diner than Owner)

C +e Signature nature sgnatwe

Date Date Date

32. 1 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 involved in the asbestos project. I hereby declare that I have authorized the fllirlg f this,notif{catio r the s ' ed herein. __ Prix Nsme of r Sgrtauxe Wte

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

[IlAny modification of information provided on this form must be reported immediately in writing directly to the NYC DEP AC!. 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. I ACPr

NYC-WTC 000126548